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General NPI Number Information
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NPI Number | 1134757958
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Entity Type | Individual
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Provider Name | ALEXA ROSE COPPA DO
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Gender | Female
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Dates
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Enumeration Date | 03/28/2020
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Last Update Date | 10/24/2024
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Provider Practice Location Address
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Address Line | 3405 NJ-33 FLOOR 2
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City | NEPTUNE
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State | NJ
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Zip | 07753
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Country | US
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Telephone | 732-508-9390
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Fax |
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Provider Business Mailing Address
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Address Line | 6 FIRESIDE DR
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City | COLTS NECK
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State | NJ
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Zip | 07722-1354
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Country | US
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Telephone | 203-312-4006
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Fax |
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Authorized Official
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Title or Position |
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Name |
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Credential |
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Telephone |
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 207N00000X
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Taxonomy Name | Dermatology Physician
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License Number | 25MB12235500
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License Number State | NJ
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