Provider Demographics
NPI:1467654236
Name:COPPOLA, JOHN ANTHONY
Entity Type:Individual
Prefix:MR
First Name:JOHN
Middle Name:ANTHONY
Last Name:COPPOLA
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 1:7321 ELM CT
Mailing Address - Street 2:
Mailing Address - City:MONMOUTH JUNCTION
Mailing Address - State:NJ
Mailing Address - Zip Code:08852-2144
Mailing Address - Country:US
Mailing Address - Phone:732-801-1012
Mailing Address - Fax:609-655-4570
Practice Address - Street 1:1 ROSSMOOR DR
Practice Address - Street 2:
Practice Address - City:MONROE TWP
Practice Address - State:NJ
Practice Address - Zip Code:08831-1566
Practice Address - Country:US
Practice Address - Phone:609-655-8866
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2007-06-04
Last Update Date:2008-08-21
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NJ25MG000907237700000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes237700000XSpeech, Language and Hearing Service ProvidersHearing Instrument Specialist