Provider Demographics
NPI:1790084846
Name:JEFF D KOPELMAN, MD. F.A.C.S. PLLC
Entity Type:Organization
Organization Name:JEFF D KOPELMAN, MD. F.A.C.S. PLLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:
Authorized Official - First Name:JEFF
Authorized Official - Middle Name:
Authorized Official - Last Name:KOPELMAN
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:516-536-4444
Mailing Address - Street 1:371 MERRICK RD
Mailing Address - Street 2:SUITE 204
Mailing Address - City:ROCKVILLE CENTRE
Mailing Address - State:NY
Mailing Address - Zip Code:11570-5359
Mailing Address - Country:US
Mailing Address - Phone:516-536-4444
Mailing Address - Fax:516-536-4486
Practice Address - Street 1:371 MERRICK RD
Practice Address - Street 2:SUITE 204
Practice Address - City:ROCKVILLE CENTRE
Practice Address - State:NY
Practice Address - Zip Code:11570-5359
Practice Address - Country:US
Practice Address - Phone:516-536-4444
Practice Address - Fax:516-536-4486
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2011-03-15
Last Update Date:2011-03-16
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes207Y00000XAllopathic & Osteopathic PhysiciansOtolaryngologyGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
6M4661Medicare UPIN