Healthcare Provider Details

I. General information

NPI: 1578757175
Provider Name (Legal Business Name): ALFRED WALTER KOPF M.D.
Entity Type: Individual
Gender: Male
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 08/28/2007
Last Update Date: 12/21/2025
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

550 1ST AVE
NEW YORK NY
10016-6402
US

IV. Provider business mailing address

60 ANTLERS DR
LAKE GEORGE NY
12845-6725
US

V. Phone/Fax

Practice location:
  • Phone: 212-263-5260
  • Fax: 518-668-9211
Mailing address:
  • Phone: 518-668-9662
  • Fax: 518-668-9211

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code207N00000X
TaxonomyDermatology Physician
License Number073842
License Number StateNY

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: