Provider Demographics
NPI:1497842678
Name:POPP, ARTHUR LEWIS (PHD)
Entity Type:Individual
Prefix:DR
First Name:ARTHUR
Middle Name:LEWIS
Last Name:POPP
Suffix:
Gender:M
Credentials:PHD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:24 BURTON AVE
Mailing Address - Street 2:
Mailing Address - City:WOODMERE
Mailing Address - State:NY
Mailing Address - Zip Code:11598-1720
Mailing Address - Country:US
Mailing Address - Phone:516-528-6501
Mailing Address - Fax:
Practice Address - Street 1:1226 W BROADWAY
Practice Address - Street 2:
Practice Address - City:HEWLETT
Practice Address - State:NY
Practice Address - Zip Code:11557-1923
Practice Address - Country:US
Practice Address - Phone:516-374-5331
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2006-10-06
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY009620103T00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes103T00000XBehavioral Health & Social Service ProvidersPsychologist
Provider Identifiers
StateIdentifier IDID TypeIssuer
NYV3J541Medicare ID - Type Unspecified