Healthcare Provider Details

I. General information

NPI: 1487729356
Provider Name (Legal Business Name): BARBARA SUE KOPPEL M.D.
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 11/22/2006
Last Update Date: 07/08/2007
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1901 1ST AVE 7C5
NEW YORK NY
10029-7404
US

IV. Provider business mailing address

55 GRACE CHURCH ST
RYE NY
10580-3926
US

V. Phone/Fax

Practice location:
  • Phone: 212-423-6676
  • Fax: 212-423-7851
Mailing address:
  • Phone: 212-423-6676
  • Fax: 212-423-7851

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code2084N0400X
TaxonomyNeurology Physician
License Number138821
License Number StateNY

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: