Provider Demographics
NPI:1225083546
Name:KOPSTICK, ELIYAHU SAMUEL (DO)
Entity Type:Individual
Prefix:DR
First Name:ELIYAHU
Middle Name:SAMUEL
Last Name:KOPSTICK
Suffix:
Gender:M
Credentials:DO
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:2315 VICTORY BLVD
Mailing Address - Street 2:
Mailing Address - City:STATEN ISLAND
Mailing Address - State:NY
Mailing Address - Zip Code:10314-6623
Mailing Address - Country:US
Mailing Address - Phone:718-477-6900
Mailing Address - Fax:718-477-7862
Practice Address - Street 1:2315 VICTORY BLVD
Practice Address - Street 2:
Practice Address - City:STATEN ISLAND
Practice Address - State:NY
Practice Address - Zip Code:10314-6623
Practice Address - Country:US
Practice Address - Phone:718-477-6900
Practice Address - Fax:718-477-7862
Is Sole Proprietor?:No
Enumeration Date:2006-05-24
Last Update Date:2008-03-27
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY235575207R00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207R00000XAllopathic & Osteopathic PhysiciansInternal Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
NY0414219OtherEVERCARE
NY000000116248OtherGHI HMO
NY0145896OtherGHI PPO
NY1466245OtherAETNA HMO#
NY5C7787OtherHEALTHNET ID#
NYKE5575OtherATLANTIS HEALTH PLAN
NY7270822OtherAETNA PPO#
NY235575OtherHIP
NY348ST1OtherEMPIRE BCBS
NYP3808101OtherOXFORD ID#
NYKE5575OtherATLANTIS HEALTH PLAN
NY304SH35791Medicare PIN