Provider Demographics
NPI:1659364214
Name:OPPENHEIMER, JOHN K (MD)
Entity Type:Individual
Prefix:
First Name:JOHN
Middle Name:K
Last Name:OPPENHEIMER
Suffix:
Gender:M
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:PO BOX 3137
Mailing Address - Street 2:
Mailing Address - City:SAG HARBOR
Mailing Address - State:NY
Mailing Address - Zip Code:11963-0405
Mailing Address - Country:US
Mailing Address - Phone:631-725-4600
Mailing Address - Fax:631-725-6073
Practice Address - Street 1:60 BAY ST
Practice Address - Street 2:
Practice Address - City:SAG HARBOR
Practice Address - State:NY
Practice Address - Zip Code:11963-3106
Practice Address - Country:US
Practice Address - Phone:631-725-4600
Practice Address - Fax:631-725-6073
Is Sole Proprietor?:Yes
Enumeration Date:2005-08-29
Last Update Date:2009-08-21
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY150853207R00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207R00000XAllopathic & Osteopathic PhysiciansInternal Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
NY27D922Medicare ID - Type Unspecified
NYCO7582Medicare UPIN