Healthcare Provider Details

I. General information

NPI: 1043250236
Provider Name (Legal Business Name): MARSHALL S. SKOPP D.M.D.
Entity Type: Individual
Gender: Male
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 06/07/2006
Last Update Date: 07/08/2007
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

2040 FOREST AVE
STATEN ISLAND NY
10303-1737
US

IV. Provider business mailing address

2040 FOREST AVE
STATEN ISLAND NY
10303-1737
US

V. Phone/Fax

Practice location:
  • Phone: 718-982-5230
  • Fax: 718-982-5231
Mailing address:
  • Phone: 718-982-5230
  • Fax: 718-982-5231

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code1223G0001X
TaxonomyGeneral Practice Dentistry
License Number045275
License Number StateNY

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: