Healthcare Provider Details

I. General information

NPI: 1497206288
Provider Name (Legal Business Name): JANELE COPPOLA APN, FNP-C
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 10/17/2016
Last Update Date: 04/16/2018
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

140 FRANKLIN TPKE
WALDWICK NJ
07463-1847
US

IV. Provider business mailing address

1578 RTE 23 STE 100
WAYNE NJ
07470-7516
US

V. Phone/Fax

Practice location:
  • Phone: 201-447-3603
  • Fax:
Mailing address:
  • Phone: 973-706-0238
  • Fax: 973-832-4925

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code363LF0000X
TaxonomyFamily Nurse Practitioner
License Number26NJ00678000
License Number StateNJ

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: