Provider Demographics
NPI:1851363055
Name:KOPELMAN, JEFF D
Entity Type:Individual
Prefix:
First Name:JEFF
Middle Name:D
Last Name:KOPELMAN
Suffix:
Gender:M
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:371 MERRICK RD
Mailing Address - Street 2:STE 204
Mailing Address - City:ROCKVILLE CTRE
Mailing Address - State:NY
Mailing Address - Zip Code:11570
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:STE 204
Practice Address - City:ROCKVILLE CTRE
Practice Address - State:NY
Practice Address - Zip Code:11570
Practice Address - Country:US
Practice Address - Phone:516-536-4444
Practice Address - Fax:516-536-4486
Is Sole Proprietor?:Yes
Enumeration Date:2006-02-02
Last Update Date:2011-03-16
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY162483207YX0007X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207YX0007XAllopathic & Osteopathic PhysiciansOtolaryngologyPlastic Surgery within the Head & Neck
Provider Identifiers
StateIdentifier IDID TypeIssuer
0059669OtherGHI
113616761OtherPHCS
113616761OtherMAGNA
113616761OtherMULTEP
4231401OtherAETNA
AS626OtherOXF
22597OtherVTRA
3C1114OtherHLTHNT
113616761OtherONE
9347407002OtherCIGNA
28679POtherHIP
1308635OtherFRT HLTH
6M4661Medicare ID - Type Unspecified
113616761OtherMAGNA