Provider Demographics
NPI:1578757175
Name:KOPF, ALFRED WALTER (MD)
Entity Type:Individual
Prefix:DR
First Name:ALFRED
Middle Name:WALTER
Last Name:KOPF
Suffix:
Gender:M
Credentials:MD
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Mailing Address - Street 1:60 ANTLERS DR
Mailing Address - Street 2:
Mailing Address - City:LAKE GEORGE
Mailing Address - State:NY
Mailing Address - Zip Code:12845-6725
Mailing Address - Country:US
Mailing Address - Phone:518-668-9662
Mailing Address - Fax:518-668-9211
Practice Address - Street 1:550 1ST AVE
Practice Address - Street 2:
Practice Address - City:NEW YORK
Practice Address - State:NY
Practice Address - Zip Code:10016-6402
Practice Address - Country:US
Practice Address - Phone:212-263-5260
Practice Address - Fax:518-668-9211
Is Sole Proprietor?:Yes
Enumeration Date:2007-08-28
Last Update Date:2010-05-03
Deactivation Date:
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Provider Licenses
StateLicense IDTaxonomies
NY073842207N00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207N00000XAllopathic & Osteopathic PhysiciansDermatology
Provider Identifiers
StateIdentifier IDID TypeIssuer
NYB00011Medicare UPIN