Provider Demographics
NPI:1902945215
Name:KOPEC, VICTORIA (AUD)
Entity Type:Individual
Prefix:DR
First Name:VICTORIA
Middle Name:
Last Name:KOPEC
Suffix:
Gender:F
Credentials:AUD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:640 BELLE TERRE RD STE C
Mailing Address - Street 2:EAR WORKS
Mailing Address - City:PORT JEFFERSON
Mailing Address - State:NY
Mailing Address - Zip Code:11777-1936
Mailing Address - Country:US
Mailing Address - Phone:631-928-4599
Mailing Address - Fax:631-928-5542
Practice Address - Street 1:640 BELLE TERRE RD STE C
Practice Address - Street 2:EAR WORKS
Practice Address - City:PORT JEFFERSON
Practice Address - State:NY
Practice Address - Zip Code:11777-1936
Practice Address - Country:US
Practice Address - Phone:631-928-4599
Practice Address - Fax:631-928-5542
Is Sole Proprietor?:No
Enumeration Date:2007-02-05
Last Update Date:2008-06-06
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY00144-1231H00000X
NY14000006852237600000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes237600000XSpeech, Language and Hearing Service ProvidersAudiologist-Hearing Aid Fitter
No231H00000XSpeech, Language and Hearing Service ProvidersAudiologist
Provider Identifiers
StateIdentifier IDID TypeIssuer
NY001444-1OtherHIP
NY2414342OtherUNITED HEALTHCARE
NY113630298OtherTAX ID
NYP3614952OtherOXFORD
NY71692OtherVYTRA
NYM72472OtherEMPIRE
NY4800362OtherGHI
NYM72472OtherEMPIRE