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NPI Code Detail

MEDICARE: CHRIS POPP LMT

MEDICARE: CHRIS POPP LMT
Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

# Taxonomy Code Taxonomy License Number License Number State
1174400000XSpecialist006341-1NY

Other Identifiers

# Provider Identifier Provider Identifier Type Provider Identifier State Provider Identifier Issuer
1006341-1OTHERNYLICENSE

General Provider Information

NPI Number : 1154664308
Entity Type Code : Individual
Provider Name (Legal Business Name) : CHRIS POPP LMT
Provider Business Mailing Address
First Line : 375 NORTH BROADWAY, SUITE LL2
Second Line : C/O MMS
City : JERICHO
State : NY
Zip : 11753
Country : US
Telephone Number : 516-433-5018
Fax Number : 516-433-5084
Provider Business Practice Location Address
First Line : 535 BROADHOLLOW RD
Second Line :
City : MELVILLE
State : NY
Zip : 11747-3713
Country : US
Telephone Number : 516-971-5435
Fax Number :
Authorized Official
Title or Position :
Name :
Credential :
Telephone Number :
Provider Enumeration Date : 04/05/2013
Last Update Date : 04/10/2013

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