Healthcare Provider Details

I. General information

NPI: 1942425202
Provider Name (Legal Business Name): AIMEE ZOPF DMD
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 04/13/2007
Last Update Date: 07/08/2007
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

656 MAIN ST
PORT JEFFERSON NY
11777-2203
US

IV. Provider business mailing address

656 MAIN ST
PORT JEFFERSON NY
11777-2203
US

V. Phone/Fax

Practice location:
  • Phone: 631-928-9898
  • Fax: 631-928-3701
Mailing address:
  • Phone: 631-928-9898
  • Fax: 631-928-3701

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code1223G0001X
TaxonomyGeneral Practice Dentistry
License Number050379
License Number StateNY

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: