Healthcare Provider Details

I. General information

NPI: 1407386758
Provider Name (Legal Business Name): JEFFREY GROPPER DO, P.C.
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 06/19/2017
Last Update Date: 07/21/2022
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

761 MIDDLE COUNTRY RD
SELDEN NY
11784-2550
US

IV. Provider business mailing address

761 MIDDLE COUNTRY RD
SELDEN NY
11784-2550
US

V. Phone/Fax

Practice location:
  • Phone: 631-736-4064
  • Fax: 631-736-1332
Mailing address:
  • Phone: 631-736-4064
  • Fax: 631-736-1332

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code207L00000X
TaxonomyAnesthesiology Physician
License Number228979
License Number StateNY

VIII. Authorized Official

Name: JEFFREY EVAN GROPPER
Title or Position: OWNER/AUTHORIZED OFFICIAL
Credential: DO
Phone: 516-840-3364