Provider Demographics
NPI:1063490217
Name:KOPATSIS, ANTHONY (MD)
Entity Type:Individual
Prefix:DR
First Name:ANTHONY
Middle Name:
Last Name:KOPATSIS
Suffix:
Gender:M
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:PO BOX 60039
Mailing Address - Street 2:
Mailing Address - City:STATEN ISLAND
Mailing Address - State:NY
Mailing Address - Zip Code:10306-0039
Mailing Address - Country:US
Mailing Address - Phone:718-667-7009
Mailing Address - Fax:718-667-7514
Practice Address - Street 1:3163 HYLAN BLVD
Practice Address - Street 2:
Practice Address - City:STATEN ISLAND
Practice Address - State:NY
Practice Address - Zip Code:10306-4145
Practice Address - Country:US
Practice Address - Phone:718-667-7009
Practice Address - Fax:718-667-7514
Is Sole Proprietor?:No
Enumeration Date:2006-01-06
Last Update Date:2013-09-18
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY2011611208600000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes208600000XAllopathic & Osteopathic PhysiciansSurgery
Provider Identifiers
StateIdentifier IDID TypeIssuer
NY90588OtherGHI HMO
NY201161E11OtherHEALTH FIRST
NY1700922OtherUNITED HEALTHCARE MEDICAR
NY3C7017OtherPHS
NYBK0226607OtherAMERICHOICE
NYP00220301OtherRAILROAD MEDICARE
NY01860734Medicaid
NY9759204OtherGHI
NYP3568917OtherOXFORD
NY3773644OtherAETNA
NY166717OtherELDER PLAN
NY2011611OtherHIP
NY9759204OtherGHI
NYBK0226607OtherAMERICHOICE