Provider Demographics
NPI:1437531183
Name:KOPACH, NIKOLAY (LAC)
Entity Type:Individual
Prefix:
First Name:NIKOLAY
Middle Name:
Last Name:KOPACH
Suffix:
Gender:M
Credentials:LAC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:288 BAY 38TH ST
Mailing Address - Street 2:APT 7N
Mailing Address - City:BROOKLYN
Mailing Address - State:NY
Mailing Address - Zip Code:11214-6552
Mailing Address - Country:US
Mailing Address - Phone:718-288-2943
Mailing Address - Fax:
Practice Address - Street 1:288 BAY 38TH, ST APT 7N
Practice Address - Street 2:
Practice Address - City:BROOKLYN
Practice Address - State:NY
Practice Address - Zip Code:11214
Practice Address - Country:US
Practice Address - Phone:718-288-2943
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2015-06-18
Last Update Date:2015-06-18
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY004942-1171100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes171100000XOther Service ProvidersAcupuncturist