Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
Y | 1223P0300X | Periodontist | 048380 | NY |
NPI | 1093924383 |
---|---|
Provider Name | Dr. Jeffrey Alan Kopman |
First Address | Huntington, NY 11743-2923 |
Second Address | Huntington, NY 11743-2923 |
Gender | M |
NPI Entity type | Individual |
Is Sole Proprietor | No |
Is Organization Subpart | N/A |
Enumeration Date | 22/05/2007 |
Last Update Date | 08/07/2007 |