Basic Information
| Provider Information | |||||||||
| NPI: | 1902945215 | ||||||||
| EntityType: | 1 | ||||||||
| ReplacementNPI: | |||||||||
| OrganizationName: | |||||||||
| LastName: | KOPEC | ||||||||
| FirstName: | VICTORIA | ||||||||
| MiddleName: | |||||||||
| NamePrefix: | DR. | ||||||||
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| Credential: | AU.D. | ||||||||
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| Mailing Information | |||||||||
| Address1: | 640 BELLE TERRE RD STE C | ||||||||
| Address2: | EAR WORKS | ||||||||
| City: | PORT JEFFERSON | ||||||||
| State: | NY | ||||||||
| PostalCode: | 117771936 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 6319284599 | ||||||||
| FaxNumber: | 6319285542 | ||||||||
| Practice Location | |||||||||
| Address1: | 640 BELLE TERRE RD STE C | ||||||||
| Address2: | EAR WORKS | ||||||||
| City: | PORT JEFFERSON | ||||||||
| State: | NY | ||||||||
| PostalCode: | 117771936 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 6319284599 | ||||||||
| FaxNumber: | 6319285542 | ||||||||
| Other Information | |||||||||
| ProviderEnumerationDate: | 02/05/2007 | ||||||||
| LastUpdateDate: | 06/06/2008 | ||||||||
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| ProviderGenderCode: | F | ||||||||
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| IsSoleProprietor: | N | ||||||||
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Taxonomy Information
| Taxonomy | License | State | Switch | TaxonomyGroup | TaxonomyType | TaxonomyClass | SubSpecialty | 231H00000X | 00144-1 | NY | N | Speech, Language and Hearing Service Providers | Audiologist | 237600000X | 14000006852 | NY | Y | Speech, Language and Hearing Service Providers | Audiologist-Hearing Aid Fitter |
ID Information
| ID | Type | State | Issuer | Description | 001444-1 | 01 | NY | HIP | OTHER | 2414342 | 01 | NY | UNITED HEALTHCARE | OTHER | 113630298 | 01 | NY | TAX ID | OTHER | P3614952 | 01 | NY | OXFORD | OTHER | 71692 | 01 | NY | VYTRA | OTHER | M72472 | 01 | NY | EMPIRE | OTHER | 4800362 | 01 | NY | GHI | OTHER |