Healthcare Provider Details

I. General information

NPI: 1972508489
Provider Name (Legal Business Name): JAMES N KOPPEL MD
Entity Type: Individual
Gender: Male
Sole Proprietor: X

II. Dates (important events)

Enumeration Date: 06/21/2005
Last Update Date: 07/08/2007
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

410 LAKEVILLE RD STE 209
NEW HYDE PARK NY
11042-1122
US

IV. Provider business mailing address

PO BOX 1087
ROCKVILLE CENTRE NY
11571-1087
US

V. Phone/Fax

Practice location:
  • Phone: 516-488-5050
  • Fax:
Mailing address:
  • Phone: 201-804-2800
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code174400000X
TaxonomySpecialist
License NumberA133699-1
License Number StateNY

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: