Provider Demographics
NPI:1609959642
Name:KOPPELMAN, EVE DANA (PT)
Entity Type:Individual
Prefix:MRS
First Name:EVE
Middle Name:DANA
Last Name:KOPPELMAN
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 1:11 HILTON PL
Mailing Address - Street 2:
Mailing Address - City:MONTVALE
Mailing Address - State:NJ
Mailing Address - Zip Code:07645-1206
Mailing Address - Country:US
Mailing Address - Phone:201-683-3500
Mailing Address - Fax:
Practice Address - Street 1:210 SUMMIT AVE STE B1
Practice Address - Street 2:
Practice Address - City:MONTVALE
Practice Address - State:NJ
Practice Address - Zip Code:07645-1526
Practice Address - Country:US
Practice Address - Phone:201-683-3500
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2006-10-23
Last Update Date:2019-11-16
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY025621225100000X
NJ40QA01124300225100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225100000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical Therapist
Provider Identifiers
StateIdentifier IDID TypeIssuer
NYQP9811Medicare PIN