Provider Demographics
NPI:1538321542
Name:COPLOWITZ, SHANA ROSE (MD)
Entity Type:Individual
Prefix:
First Name:SHANA
Middle Name:ROSE
Last Name:COPLOWITZ
Suffix:
Gender:F
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:15 LAUREL AVE STE 100
Mailing Address - Street 2:
Mailing Address - City:CORNWALL
Mailing Address - State:NY
Mailing Address - Zip Code:12518-1403
Mailing Address - Country:US
Mailing Address - Phone:845-458-9000
Mailing Address - Fax:845-458-9001
Practice Address - Street 1:15 LAUREL AVE STE 100
Practice Address - Street 2:
Practice Address - City:CORNWALL
Practice Address - State:NY
Practice Address - Zip Code:12518-1403
Practice Address - Country:US
Practice Address - Phone:845-458-9000
Practice Address - Fax:845-458-9001
Is Sole Proprietor?:No
Enumeration Date:2008-06-30
Last Update Date:2022-07-21
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MO20150030262085R0001X
NY2699322085R0001X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes2085R0001XAllopathic & Osteopathic PhysiciansRadiologyRadiation Oncology
Provider Identifiers
StateIdentifier IDID TypeIssuer
A400085339Medicare PIN
NY03588149Medicaid