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General NPI Number Information
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NPI Number | 1790220705
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Entity Type | Organization
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Legal Business Name | WILLIAM A. COPEN, MD, PLLC
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Dates
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Enumeration Date | 12/29/2016
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Last Update Date | 03/13/2021
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Provider Practice Location Address
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Address Line | 300 E 75TH ST APT. 8B
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City | NEW YORK
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State | NY
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Zip | 10021-3375
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Country | US
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Telephone | 617-877-6278
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Fax |
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Provider Business Mailing Address
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Address Line | 1126 S FEDERAL HWY # 128
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City | FORT LAUDERDALE
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State | FL
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Zip | 33316-1257
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Country | US
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Telephone | 617-877-6278
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Fax |
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Authorized Official
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Title or Position | SOLE MEMBER
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Name | DR. WILLIAM A. COPEN
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Credential | MD
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Telephone | 617-877-6278
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 2085R0202X
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Taxonomy Name | Diagnostic Radiology Physician
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License Number | 240680
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License Number State | NY
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