Provider Demographics
NPI:1336119940
Name:KOPIDIS, NESTOR (PT)
Entity Type:Individual
Prefix:
First Name:NESTOR
Middle Name:
Last Name:KOPIDIS
Suffix:
Gender:M
Credentials:PT
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1385 BOSTON POST RD
Mailing Address - Street 2:
Mailing Address - City:LARCHMONT
Mailing Address - State:NY
Mailing Address - Zip Code:10538-3904
Mailing Address - Country:US
Mailing Address - Phone:914-834-7222
Mailing Address - Fax:
Practice Address - Street 1:52 VANDERBILT AVE
Practice Address - Street 2:SUITE 1413
Practice Address - City:NEW YORK
Practice Address - State:NY
Practice Address - Zip Code:10017-3808
Practice Address - Country:US
Practice Address - Phone:212-599-0099
Practice Address - Fax:
Is Sole Proprietor?:Not Answered
Enumeration Date:2006-01-25
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY011342225100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225100000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical Therapist
Provider Identifiers
StateIdentifier IDID TypeIssuer
NYOXFORDOtherP2630857
NYQN0401OtherEMPIRE BC/BS NUMBER
NYQN0401OtherEMPIRE BC/BS NUMBER