Provider Demographics
NPI:1487729356
Name:KOPPEL, BARBARA SUE (MD)
Entity type:Individual
Prefix:
First Name:BARBARA
Middle Name:SUE
Last Name:KOPPEL
Suffix:
Gender:F
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:55 GRACE CHURCH ST
Mailing Address - Street 2:
Mailing Address - City:RYE
Mailing Address - State:NY
Mailing Address - Zip Code:10580-3926
Mailing Address - Country:US
Mailing Address - Phone:212-423-6676
Mailing Address - Fax:212-423-7851
Practice Address - Street 1:1901 1ST AVE
Practice Address - Street 2:7C5
Practice Address - City:NEW YORK
Practice Address - State:NY
Practice Address - Zip Code:10029-7404
Practice Address - Country:US
Practice Address - Phone:212-423-6676
Practice Address - Fax:212-423-7851
Is Sole Proprietor?:Yes
Enumeration Date:2006-11-22
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY1388212084N0400X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes2084N0400XAllopathic & Osteopathic PhysiciansPsychiatry & NeurologyNeurology
Provider Identifiers
StateIdentifier IDID TypeIssuer
NY72A561Medicare ID - Type Unspecified
NYB18979Medicare UPIN