MEDICARE: MRS. ERIN COPPA M.A., CCC-SLP

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	235Z00000X	Speech-Language Pathologist	017639	NY

General Provider Information

NPI Number	:	1952554933
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	MRS. ERIN COPPA M.A., CCC-SLP

Provider Business Mailing Address
First Line	:	137 KATAN AVE
Second Line	:
City	:	STATEN ISLAND
State	:	NY
Zip	:	10308-2051
Country	:	US
Telephone Number	:	718-984-7092
Fax Number	:

Provider Business Practice Location Address
First Line	:	348 SEAVIEW AVE
Second Line	:
City	:	STATEN ISLAND
State	:	NY
Zip	:	10305-2216
Country	:	US
Telephone Number	:	718-980-1700
Fax Number	:

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

Provider Enumeration Date	:	11/04/2008
Last Update Date	:	04/24/2013

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