Provider Demographics
NPI:1962692863
Name:ANTHONY KOPATSIS MD FACS PLLC
Entity type:Organization
Organization Name:ANTHONY KOPATSIS MD FACS PLLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:BILLING MANAGER
Authorized Official - Prefix:MS
Authorized Official - First Name:SHEREE
Authorized Official - Middle Name:
Authorized Official - Last Name:ROTH
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:732-608-6639
Mailing Address - Street 1:PO BOX 60039
Mailing Address - Street 2:
Mailing Address - City:STATEN ISLAND
Mailing Address - State:NY
Mailing Address - Zip Code:10306-0039
Mailing Address - Country:US
Mailing Address - Phone:718-667-7009
Mailing Address - Fax:718-667-7514
Practice Address - Street 1:3163 HYLAN BLVD
Practice Address - Street 2:
Practice Address - City:STATEN ISLAND
Practice Address - State:NY
Practice Address - Zip Code:10306-4145
Practice Address - Country:US
Practice Address - Phone:718-667-7009
Practice Address - Fax:718-667-7514
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2007-07-26
Last Update Date:2013-09-19
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY2011611208600000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes208600000XAllopathic & Osteopathic PhysiciansSurgeryGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
NY01860737Medicaid
NYG68265Medicare UPIN
NYAK0WEV6610Medicare PIN
NYWEV661Medicare PIN