1417933144 NPI number — DR. GENE COPPA MD

Table of content: DR. GENE COPPA MD (NPI 1417933144)

General

This information contains only most important part of the NPI data, for complete information, including NPI referencing materials please refer to 1417933144 NPI number — DR. GENE COPPA MD

Organization/Personal Information

Employer Identification Number (EIN):
Provider Organization Name:
Provider Last Name:
COPPA
Provider First Name:
GENE
Provider Middle Name:
Provider Name Prefix Text:
DR.
Provider Name Suffix Text:
Provider Credential Text:
MD
Provider Gender Code:
M

Provider's Other Name Information

Provider Other Organization Name:
Provider Other Organization Name Type Code:
Provider Other Last Name:
Provider Other First Name:
Provider Other Middle Name:
Provider Other Name Prefix Text:
Provider Other Name Suffix Text:
Provider Other Credential Text:
Provider Other Last Name Type Code:

NPI Number Information

NPI Number:
1417933144
Entity Type Code:
Individual
Replacement NPI:
Last Update Date:
04/14/2014
NPI Deactivation Reason Code:
NPI Deactivation Date:
NPI Reactivation Date:

Provider's Business Mailing Address

Provider First Line Business Mailing Address:
300 COMMUNITY DR
Provider Second Line Business Mailing Address:
CHAIRMANS OFFICE 6 MONTI
Provider Business Mailing Address City Name:
MANHASSET
Provider Business Mailing Address State Name:
NY
Provider Business Mailing Address Postal Code:
11030-3816
Provider Business Mailing Address Country Code:
US
Provider Business Mailing Address Telephone Number:
516-562-2870
Provider Business Mailing Address Fax Number:
516-562-4821

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
1991 MARCUS AVE
Provider Second Line Business Practice Location Address:
SUITE 102
Provider Business Practice Location Address City Name:
NEW HYDE PARK
Provider Business Practice Location Address State Name:
NY
Provider Business Practice Location Address Postal Code:
11042-2057
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
516-562-2870
Provider Business Practice Location Address Fax Number:
516-562-4821
Provider Enumeration Date:
12/15/2005

Additional Information

Authorized Official

Authorized Official Last Name:
Authorized Official First Name:
Authorized Official Middle Name:
Authorized Official Title or Position:
Authorized Official Telephone Number:

Provider Taxonomy Codes

  • Taxonomy code: 208600000X , with the licence number:  124834 , registered in the state of NY ; information, associated with the NPI states the following Primary Taxonomy Switch: "Y" .

Other Provider's Identifiers (legacy, non-NPI)

  • Identifier: 01435625 , issued by the state of ( NY ) . This identifiers is of the category "MEDICAID".




Copyright © 2007-2024 www.npivalidator.com