Healthcare Provider Details

I. General information

NPI: 1932109170
Provider Name (Legal Business Name): TODD S. KOPPEL MD
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 07/29/2005
Last Update Date: 05/20/2011
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

721 CLIFTON AVE SUITE 2D
CLIFTON NJ
07013-1880
US

IV. Provider business mailing address

118 N BEDFORD RD SUITE 200
MOUNT KISCO NY
10549-2553
US

V. Phone/Fax

Practice location:
  • Phone: 973-473-5752
  • Fax:
Mailing address:
  • Phone: 914-666-8866
  • Fax: 914-666-6777

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code207LP2900X
TaxonomyPain Medicine (Anesthesiology) Physician
License Number65665
License Number StateNJ
# 2
Primary TaxonomyN
Taxonomy Code207LP2900X
TaxonomyPain Medicine (Anesthesiology) Physician
License Number201176
License Number StateNY

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: