Provider Demographics
NPI:1356744650
Name:KOPP, AVRIEL SARAH (PA-C)
Entity type:Individual
Prefix:MRS
First Name:AVRIEL
Middle Name:SARAH
Last Name:KOPP
Suffix:
Gender:F
Credentials:PA-C
Other - Prefix:MS
Other - First Name:AVRIEL
Other - Middle Name:SARAH
Other - Last Name:HARRINGTON
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:PA-C
Mailing Address - Street 1:6645 MAIN ST SUITE B
Mailing Address - Street 2:ENT CARE OF WNY
Mailing Address - City:WILLIAMSVILLE
Mailing Address - State:NY
Mailing Address - Zip Code:14221
Mailing Address - Country:US
Mailing Address - Phone:716-634-6224
Mailing Address - Fax:716-634-3816
Practice Address - Street 1:6645 MAIN ST. SUITE B
Practice Address - Street 2:ENT CARE OF WNY
Practice Address - City:WILLIAMSVILLE
Practice Address - State:NY
Practice Address - Zip Code:14221
Practice Address - Country:US
Practice Address - Phone:716-634-6224
Practice Address - Fax:716-634-3816
Is Sole Proprietor?:No
Enumeration Date:2014-09-30
Last Update Date:2016-01-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY23 017630363A00000X
NY017630363AM0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363AM0700XPhysician Assistants & Advanced Practice Nursing ProvidersPhysician AssistantMedical
No363A00000XPhysician Assistants & Advanced Practice Nursing ProvidersPhysician Assistant