Healthcare Provider Details

I. General information

NPI: 1336119940
Provider Name (Legal Business Name): NESTOR KOPIDIS PT
Entity Type: Individual
Gender: Male
Sole Proprietor: X

II. Dates (important events)

Enumeration Date: 01/25/2006
Last Update Date: 07/08/2007
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

52 VANDERBILT AVE SUITE 1413
NEW YORK NY
10017-3808
US

IV. Provider business mailing address

1385 BOSTON POST RD
LARCHMONT NY
10538-3904
US

V. Phone/Fax

Practice location:
  • Phone: 212-599-0099
  • Fax:
Mailing address:
  • Phone: 914-834-7222
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code225100000X
TaxonomyPhysical Therapist
License Number011342
License Number StateNY

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: