Healthcare Provider Details

I. General information

NPI: 1861731556
Provider Name (Legal Business Name): ANTHONY COPPOLA JR. M.A.
Entity Type: Individual
Gender: Male
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 01/31/2013
Last Update Date: 01/31/2013
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

201 PRESIDENT ST
HEMPSTEAD NY
11550-4718
US

IV. Provider business mailing address

436A FRONT ST
HEMPSTEAD NY
11550-4212
US

V. Phone/Fax

Practice location:
  • Phone: 516-292-7111
  • Fax:
Mailing address:
  • Phone: 516-292-7111
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code235Z00000X
TaxonomySpeech-Language Pathologist
License Number003091
License Number StateNY

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: