MEDICARE: DR. ADAM KOPPELMAN DMD

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
1	390200000X	Student in an Organized Health Care Education/Training Program
2	122300000X	Dentist	054567	NY

General Provider Information

NPI Number	:	1245477504
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	DR. ADAM KOPPELMAN DMD

Provider Business Mailing Address
First Line	:	9 W 31ST ST
Second Line	:	APT 18F
City	:	NEW YORK
State	:	NY
Zip	:	10001-4474
Country	:	US
Telephone Number	:
Fax Number	:

Provider Business Practice Location Address
First Line	:	7 W 45TH ST
Second Line	:	2ND FL
City	:	NEW YORK
State	:	NY
Zip	:	10036-4905
Country	:	US
Telephone Number	:	212-382-3782
Fax Number	:

Authorized Official
Title or Position	:
Name	:
Credential	:
Telephone Number	:

Provider Enumeration Date	:	01/08/2009
Last Update Date	:	04/18/2016

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