Provider Demographics
NPI:1578291712
Name:KOPIT, ELISE MALIN
Entity Type:Individual
Prefix:
First Name:ELISE
Middle Name:MALIN
Last Name:KOPIT
Suffix:
Gender:F
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:23220 WENDOVER DR
Mailing Address - Street 2:
Mailing Address - City:BEACHWOOD
Mailing Address - State:OH
Mailing Address - Zip Code:44122-1445
Mailing Address - Country:US
Mailing Address - Phone:216-407-5346
Mailing Address - Fax:
Practice Address - Street 1:23220 WENDOVER DR
Practice Address - Street 2:
Practice Address - City:BEACHWOOD
Practice Address - State:OH
Practice Address - Zip Code:44122-1445
Practice Address - Country:US
Practice Address - Phone:216-497-5346
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2022-08-14
Last Update Date:2022-08-14
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
253Z00000X
OH253Z00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes253Z00000XAgenciesIn Home Supportive Care
Provider Identifiers
StateIdentifier IDID TypeIssuer
OH1823094OtherDODD