Provider Demographics
NPI:1720739246
Name:KOPPEL, AARON BERNARD (PA)
Entity Type:Individual
Prefix:
First Name:AARON
Middle Name:BERNARD
Last Name:KOPPEL
Suffix:
Gender:M
Credentials:PA
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
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Other - Credentials:
Mailing Address - Street 1:613 JUNE PL
Mailing Address - Street 2:
Mailing Address - City:VALLEY STREAM
Mailing Address - State:NY
Mailing Address - Zip Code:11581-3023
Mailing Address - Country:US
Mailing Address - Phone:516-492-8815
Mailing Address - Fax:
Practice Address - Street 1:613 JUNE PL
Practice Address - Street 2:
Practice Address - City:VALLEY STREAM
Practice Address - State:NY
Practice Address - Zip Code:11581-3023
Practice Address - Country:US
Practice Address - Phone:516-492-8815
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2022-01-17
Last Update Date:2022-01-17
Deactivation Date:
Deactivation Code:
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Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363A00000XPhysician Assistants & Advanced Practice Nursing ProvidersPhysician Assistant