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General NPI Number Information
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NPI Number | 1962692863
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Entity Type | Organization
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Legal Business Name | ANTHONY KOPATSIS MD FACS PLLC
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Dates
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Enumeration Date | 07/26/2007
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Last Update Date | 09/19/2013
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Provider Practice Location Address
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Address Line | 3163 HYLAN BLVD
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City | STATEN ISLAND
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State | NY
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Zip | 10306-4145
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Country | US
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Telephone | 718-667-7009
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Fax | 718-667-7514
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Provider Business Mailing Address
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Address Line | PO BOX 60039
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City | STATEN ISLAND
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State | NY
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Zip | 10306-0039
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Country | US
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Telephone | 718-667-7009
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Fax | 718-667-7514
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Authorized Official
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Title or Position | BILLING MANAGER
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Name | MS. SHEREE ROTH
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Credential |
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Telephone | 732-608-6639
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 208600000X
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Taxonomy Name | Surgery Physician
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License Number | 2011611
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License Number State | NY
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