=====================================================
General NPI Number Information
=====================================================
NPI Number | 1699913699
-----------------------------------------------------
Entity Type | Individual
-----------------------------------------------------
Provider Name | HELEN I KOPYOFF D.D.S.
-----------------------------------------------------
Gender | Female
-----------------------------------------------------
=====================================================
Dates
=====================================================
Enumeration Date | 01/29/2009
-----------------------------------------------------
Last Update Date | 02/24/2018
-----------------------------------------------------
=====================================================
Provider Practice Location Address
=====================================================
Address Line | 4222 HYLAN BLVD
-----------------------------------------------------
City | STATEN ISLAND
-----------------------------------------------------
State | NY
-----------------------------------------------------
Zip | 10308-3360
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 718-356-2700
-----------------------------------------------------
Fax | 718-356-6238
-----------------------------------------------------
=====================================================
Provider Business Mailing Address
=====================================================
Address Line | 1719 QUENTIN RD. APT 6C
-----------------------------------------------------
City | BROOKLYN
-----------------------------------------------------
State | NY
-----------------------------------------------------
Zip | 11229-1219
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 347-426-8644
-----------------------------------------------------
Fax | 347-371-9341
-----------------------------------------------------
=====================================================
Authorized Official
=====================================================
Title or Position |
-----------------------------------------------------
Name |
-----------------------------------------------------
Credential |
-----------------------------------------------------
Telephone |
-----------------------------------------------------
=====================================================
Scope of Practice (Provider's specialty)
=====================================================
Taxonomy #1
-----------------------------------------------------
Taxonomy Code | 1223G0001X
-----------------------------------------------------
Taxonomy Name | General Practice Dentistry
-----------------------------------------------------
License Number | 054476
-----------------------------------------------------
License Number State | NY
-----------------------------------------------------