Provider Demographics
NPI:1346468600
Name:COPLAN, JEREMY D (MD)
Entity Type:Individual
Prefix:DR
First Name:JEREMY
Middle Name:D
Last Name:COPLAN
Suffix:
Gender:M
Credentials:MD
Other - Prefix:
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Other - Credentials:
Mailing Address - Street 1:3829 OCEAN VIEW AVE
Mailing Address - Street 2:
Mailing Address - City:BROOKLYN
Mailing Address - State:NY
Mailing Address - Zip Code:11224-1343
Mailing Address - Country:US
Mailing Address - Phone:718-373-2622
Mailing Address - Fax:718-270-8826
Practice Address - Street 1:1165 NORTHERN BLVD.
Practice Address - Street 2:SUITE 200
Practice Address - City:MANHASSET
Practice Address - State:NY
Practice Address - Zip Code:11030
Practice Address - Country:US
Practice Address - Phone:516-365-3300
Practice Address - Fax:718-270-8826
Is Sole Proprietor?:Yes
Enumeration Date:2007-04-23
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
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Provider Licenses
StateLicense IDTaxonomies
NY1765502084P0015X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes2084P0015XAllopathic & Osteopathic PhysiciansPsychiatry & NeurologyPsychosomatic Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
NY35F083Medicare ID - Type Unspecified
NYE89062Medicare UPIN