Provider Demographics
NPI:1417933144
Name:COPPA, GENE (MD)
Entity Type:Individual
Prefix:DR
First Name:GENE
Middle Name:
Last Name:COPPA
Suffix:
Gender:M
Credentials:MD
Other - Prefix:
Other - First Name:
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Other - Credentials:
Mailing Address - Street 1:300 COMMUNITY DR
Mailing Address - Street 2:CHAIRMANS OFFICE 6 MONTI
Mailing Address - City:MANHASSET
Mailing Address - State:NY
Mailing Address - Zip Code:11030-3816
Mailing Address - Country:US
Mailing Address - Phone:516-562-2870
Mailing Address - Fax:516-562-4821
Practice Address - Street 1:1991 MARCUS AVE
Practice Address - Street 2:SUITE 102
Practice Address - City:NEW HYDE PARK
Practice Address - State:NY
Practice Address - Zip Code:11042-2057
Practice Address - Country:US
Practice Address - Phone:516-562-2870
Practice Address - Fax:516-562-4821
Is Sole Proprietor?:No
Enumeration Date:2005-12-15
Last Update Date:2014-04-14
Deactivation Date:
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Provider Licenses
StateLicense IDTaxonomies
NY124834208600000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes208600000XAllopathic & Osteopathic PhysiciansSurgery
Provider Identifiers
StateIdentifier IDID TypeIssuer
NY01435625Medicaid
NY01435625Medicaid
NY11A971Medicare PIN
NYB00141Medicare UPIN