Provider Demographics
NPI:1073854980
Name:GOPICO, NECIAS (RPT)
Entity Type:Individual
Prefix:
First Name:NECIAS
Middle Name:
Last Name:GOPICO
Suffix:
Gender:M
Credentials:RPT
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:81 MORRIS AVE APT 29
Mailing Address - Street 2:
Mailing Address - City:SPRINGFIELD
Mailing Address - State:NJ
Mailing Address - Zip Code:07081-1424
Mailing Address - Country:US
Mailing Address - Phone:973-376-8034
Mailing Address - Fax:
Practice Address - Street 1:3135 31ST ST
Practice Address - Street 2:
Practice Address - City:ASTORIA
Practice Address - State:NY
Practice Address - Zip Code:11106-2591
Practice Address - Country:US
Practice Address - Phone:718-274-1300
Practice Address - Fax:718-274-0300
Is Sole Proprietor?:Yes
Enumeration Date:2013-03-04
Last Update Date:2013-03-04
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY030188225100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225100000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical Therapist