Healthcare Provider Details

I. General information

NPI: 1578588703
Provider Name (Legal Business Name): HEIDI ROPPELT M.D.
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 07/12/2006
Last Update Date: 09/21/2016
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

147 BEACH RD SUITE D
WESTHAMPTON BEACH NY
11978-1733
US

IV. Provider business mailing address

147 BEACH RD SUITE D
WESTHAMPTON BEACH NY
11978-1733
US

V. Phone/Fax

Practice location:
  • Phone: 631-405-3325
  • Fax: 631-237-3164
Mailing address:
  • Phone: 631-405-3325
  • Fax: 631-237-3164

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code207RR0500X
TaxonomyRheumatology Physician
License Number234902
License Number StateNY

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: