Provider Demographics
NPI:1790220705
Name:WILLIAM A. COPEN, MD, PLLC
Entity Type:Organization
Organization Name:WILLIAM A. COPEN, MD, PLLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:SOLE MEMBER
Authorized Official - Prefix:DR
Authorized Official - First Name:WILLIAM
Authorized Official - Middle Name:A
Authorized Official - Last Name:COPEN
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:617-877-6278
Mailing Address - Street 1:1126 S FEDERAL HWY # 128
Mailing Address - Street 2:
Mailing Address - City:FORT LAUDERDALE
Mailing Address - State:FL
Mailing Address - Zip Code:33316-1257
Mailing Address - Country:US
Mailing Address - Phone:617-877-6278
Mailing Address - Fax:
Practice Address - Street 1:300 E 75TH ST
Practice Address - Street 2:APT. 8B
Practice Address - City:NEW YORK
Practice Address - State:NY
Practice Address - Zip Code:10021-3375
Practice Address - Country:US
Practice Address - Phone:617-877-6278
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2016-12-29
Last Update Date:2021-03-13
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY2406802085R0202X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes2085R0202XAllopathic & Osteopathic PhysiciansRadiologyDiagnostic RadiologyGroup - Single Specialty