Provider Demographics
NPI:1356439988
Name:COPPOLA, CHARLES CARMEN (DC)
Entity Type:Individual
Prefix:DR
First Name:CHARLES
Middle Name:CARMEN
Last Name:COPPOLA
Suffix:
Gender:M
Credentials:DC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1 S STONE AVE
Mailing Address - Street 2:
Mailing Address - City:ELMSFORD
Mailing Address - State:NY
Mailing Address - Zip Code:10523-3612
Mailing Address - Country:US
Mailing Address - Phone:914-592-1733
Mailing Address - Fax:914-347-2183
Practice Address - Street 1:1 S STONE AVE
Practice Address - Street 2:
Practice Address - City:ELMSFORD
Practice Address - State:NY
Practice Address - Zip Code:10523-3612
Practice Address - Country:US
Practice Address - Phone:914-592-1733
Practice Address - Fax:914-347-2183
Is Sole Proprietor?:Yes
Enumeration Date:2006-10-10
Last Update Date:2011-11-18
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NYX3723111N00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes111N00000XChiropractic ProvidersChiropractor
Provider Identifiers
StateIdentifier IDID TypeIssuer
NYX21321Medicare PIN