Provider Demographics
NPI:1003510439
Name:COPLIN, TONY
Entity Type:Individual
Prefix:
First Name:TONY
Middle Name:
Last Name:COPLIN
Suffix:
Gender:M
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:5334 N SYDENHAM ST
Mailing Address - Street 2:
Mailing Address - City:PHILADELPHIA
Mailing Address - State:PA
Mailing Address - Zip Code:19141-1620
Mailing Address - Country:US
Mailing Address - Phone:267-734-6853
Mailing Address - Fax:
Practice Address - Street 1:5334 N SYDENHAM ST
Practice Address - Street 2:
Practice Address - City:PHILADELPHIA
Practice Address - State:PA
Practice Address - Zip Code:19141-1620
Practice Address - Country:US
Practice Address - Phone:267-734-6853
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2023-03-29
Last Update Date:2023-03-29
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
PA68953601385H00000X, 376J00000X, 376K00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes376J00000XNursing Service Related ProvidersHomemaker
No385H00000XRespite Care FacilityRespite Care
No376K00000XNursing Service Related ProvidersNurse's Aide