MEDICARE: DR. GENE COPPA MD

Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

#	Taxonomy Code	Taxonomy	License Number	License Number State
1	208600000X	Surgery Physician	124834	NY

Other Identifiers

#	Provider Identifier	Provider Identifier Type	Provider Identifier State	Provider Identifier Issuer
1	MEDICAID ID Found: Get Medicaid Details using Online Medicaid Verification Program

General Provider Information

NPI Number	:	1417933144
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	DR. GENE COPPA MD

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

Provider Business Practice Location Address
First Line	:	1991 MARCUS AVE
Second Line	:	SUITE 102
City	:	NEW HYDE PARK
State	:	NY
Zip	:	11042-2057
Country	:	US
Telephone Number	:	516-562-2870
Fax Number	:	516-562-4821

Authorized Official
Title or Position	:
Name	:
Credential	:
Telephone Number	:

Provider Enumeration Date	:	12/15/2005
Last Update Date	:	04/14/2014

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