Provider Demographics
NPI:1528025434
Name:KOOP, JANE ANN (ANP-C)
Entity Type:Individual
Prefix:MS
First Name:JANE
Middle Name:ANN
Last Name:KOOP
Suffix:
Gender:F
Credentials:ANP-C
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:272 JOHNSON AVE
Mailing Address - Street 2:
Mailing Address - City:SAYVILLE
Mailing Address - State:NY
Mailing Address - Zip Code:11782-1144
Mailing Address - Country:US
Mailing Address - Phone:631-589-4624
Mailing Address - Fax:
Practice Address - Street 1:500 W MAIN ST
Practice Address - Street 2:SUITE 110
Practice Address - City:BABYLON
Practice Address - State:NY
Practice Address - Zip Code:11702-3027
Practice Address - Country:US
Practice Address - Phone:631-669-4500
Practice Address - Fax:631-669-7710
Is Sole Proprietor?:Not Answered
Enumeration Date:2006-04-26
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY303829363LA2200X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LA2200XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerAdult Health