Healthcare Provider Details

I. General information

NPI: 1104768183
Provider Name (Legal Business Name): VEIN RELIEF CENTER PA
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 04/08/2026
Last Update Date: 04/08/2026
Certification Date: 04/08/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

543 45TH ST
UNION CITY NJ
07087-2615
US

IV. Provider business mailing address

543 45TH ST
UNION CITY NJ
07087-2615
US

V. Phone/Fax

Practice location:
  • Phone: 201-766-6469
  • Fax: 201-662-7195
Mailing address:
  • Phone: 201-766-6469
  • Fax: 201-662-7195

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code207LP2900X
TaxonomyPain Medicine (Anesthesiology) Physician
License Number
License Number State

VIII. Authorized Official

Name: DR. TODD S KOPPEL
Title or Position: OWNER
Credential: KOPPEL
Phone: 917-797-9523