Provider Demographics
NPI:1922286871
Name:NEIL J KOPPEL DC PC
Entity Type:Organization
Organization Name:NEIL J KOPPEL DC PC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:DR
Authorized Official - First Name:NEIL
Authorized Official - Middle Name:J
Authorized Official - Last Name:KOPPEL
Authorized Official - Suffix:
Authorized Official - Credentials:DC LAC
Authorized Official - Phone:516-504-4040
Mailing Address - Street 1:4500 EXECUTIVE DR
Mailing Address - Street 2:SUITE 330
Mailing Address - City:NAPLES
Mailing Address - State:FL
Mailing Address - Zip Code:34119-8939
Mailing Address - Country:US
Mailing Address - Phone:239-214-0214
Mailing Address - Fax:
Practice Address - Street 1:444 LAKEVILLE RD
Practice Address - Street 2:SUITE 203
Practice Address - City:LAKE SUCCESS
Practice Address - State:NY
Practice Address - Zip Code:11042-1165
Practice Address - Country:US
Practice Address - Phone:516-504-4040
Practice Address - Fax:516-482-1948
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2008-02-02
Last Update Date:2016-05-13
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NYX008178111N00000X, 111N00000X
NY002077171100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes111N00000XChiropractic ProvidersChiropractorGroup - Multi-Specialty
No171100000XOther Service ProvidersAcupuncturistGroup - Multi-Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
NYCO8178-1OtherNYS WC #
NY002077OtherNY ACU LIC #
NYX75291OtherMEICARE INDIVIDUAL PROV #
NYX008178OtherNY CHIRO LIC #
NYX75291OtherMEICARE INDIVIDUAL PROV #
NYX008178OtherNY CHIRO LIC #
NYXQW801Medicare PIN
NYU62767Medicare UPIN
NY5804163OtherGH1 PROV #