Healthcare Provider Details

I. General information

NPI: 1790393585
Provider Name (Legal Business Name): JOHN ANTHONY COPAS PMHNP
Entity Type: Individual
Gender: Male
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 07/17/2020
Last Update Date: 12/08/2025
Certification Date: 12/08/2025
Deactivation Date:
Reactivation Date:

III. Provider practice location address

621 10TH ST
NIAGARA FALLS NY
14301-1813
US

IV. Provider business mailing address

621 10TH ST
NIAGARA FALLS NY
14301-1813
US

V. Phone/Fax

Practice location:
  • Phone: 716-278-4695
  • Fax:
Mailing address:
  • Phone: 716-278-4151
  • Fax: 716-278-4149

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code363LP0808X
TaxonomyPsychiatric/Mental Health Nurse Practitioner
License Number403046
License Number StateNY

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: