Healthcare Provider Details

I. General information

NPI: 1851363055
Provider Name (Legal Business Name): JEFF D KOPELMAN
Entity Type: Individual
Gender: Male
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 02/02/2006
Last Update Date: 03/16/2011
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

371 MERRICK RD STE 204
ROCKVILLE CTRE NY
11570
US

IV. Provider business mailing address

371 MERRICK RD STE 204
ROCKVILLE CTRE NY
11570
US

V. Phone/Fax

Practice location:
  • Phone: 516-536-4444
  • Fax: 516-536-4486
Mailing address:
  • Phone: 516-536-4444
  • Fax: 516-536-4486

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code207YX0007X
TaxonomyPlastic Surgery within the Head & Neck (Otolaryngology) Physician
License Number162483
License Number StateNY

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: