Provider Demographics
NPI:1154664308
Name:POPP, CHRIS (LMT)
Entity Type:Individual
Prefix:
First Name:CHRIS
Middle Name:
Last Name:POPP
Suffix:
Gender:M
Credentials:LMT
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:375 NORTH BROADWAY, SUITE LL2
Mailing Address - Street 2:C/O MMS
Mailing Address - City:JERICHO
Mailing Address - State:NY
Mailing Address - Zip Code:11753
Mailing Address - Country:US
Mailing Address - Phone:516-433-5018
Mailing Address - Fax:516-433-5084
Practice Address - Street 1:535 BROADHOLLOW RD
Practice Address - Street 2:
Practice Address - City:MELVILLE
Practice Address - State:NY
Practice Address - Zip Code:11747-3713
Practice Address - Country:US
Practice Address - Phone:516-971-5435
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2013-04-05
Last Update Date:2013-04-10
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY006341-1174400000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes174400000XOther Service ProvidersSpecialist
Provider Identifiers
StateIdentifier IDID TypeIssuer
NY006341-1OtherLICENSE