Provider Demographics
NPI:1417470493
Name:KOPPENHEIM, SORAH CHAYA (MS)
Entity Type:Individual
Prefix:
First Name:SORAH
Middle Name:CHAYA
Last Name:KOPPENHEIM
Suffix:
Gender:F
Credentials:MS
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:116 E 9TH ST
Mailing Address - Street 2:
Mailing Address - City:LAKEWOOD
Mailing Address - State:NJ
Mailing Address - Zip Code:08701-2029
Mailing Address - Country:US
Mailing Address - Phone:732-674-9535
Mailing Address - Fax:
Practice Address - Street 1:116 E 9TH ST
Practice Address - Street 2:
Practice Address - City:LAKEWOOD
Practice Address - State:NJ
Practice Address - Zip Code:08701-2029
Practice Address - Country:US
Practice Address - Phone:732-674-9535
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2017-07-20
Last Update Date:2022-07-21
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes106S00000XBehavioral Health & Social Service ProvidersBehavior Technician