Provider Demographics
NPI:1376662882
Name:COPLAN, STACEY (PT)
Entity Type:Individual
Prefix:MS
First Name:STACEY
Middle Name:
Last Name:COPLAN
Suffix:
Gender:F
Credentials:PT
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:301 E 73RD ST
Mailing Address - Street 2:APT 5E
Mailing Address - City:NEW YORK
Mailing Address - State:NY
Mailing Address - Zip Code:10021-9400
Mailing Address - Country:US
Mailing Address - Phone:212-472-6634
Mailing Address - Fax:
Practice Address - Street 1:301 E 73RD ST
Practice Address - Street 2:APT 5E
Practice Address - City:NEW YORK
Practice Address - State:NY
Practice Address - Zip Code:10021-9400
Practice Address - Country:US
Practice Address - Phone:212-472-6634
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2007-03-28
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY024896225100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225100000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical Therapist