Provider Demographics
NPI:1558334375
Name:COPPOLA, JOHN T (MD)
Entity type:Individual
Prefix:
First Name:JOHN
Middle Name:T
Last Name:COPPOLA
Suffix:
Gender:M
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
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Other - Credentials:
Mailing Address - Street 1:340 ROUTE 34 STE 201
Mailing Address - Street 2:
Mailing Address - City:COLTS NECK
Mailing Address - State:NJ
Mailing Address - Zip Code:07722-2434
Mailing Address - Country:US
Mailing Address - Phone:732-487-3636
Mailing Address - Fax:732-487-3635
Practice Address - Street 1:340 ROUTE 34 STE 201
Practice Address - Street 2:
Practice Address - City:COLTS NECK
Practice Address - State:NJ
Practice Address - Zip Code:07722-2434
Practice Address - Country:US
Practice Address - Phone:732-487-3636
Practice Address - Fax:732-487-3635
Is Sole Proprietor?:No
Enumeration Date:2006-02-10
Last Update Date:2025-09-10
Deactivation Date:
Deactivation Code:
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Provider Licenses
StateLicense IDTaxonomies
NJ25MA12855200207RI0011X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207RI0011XAllopathic & Osteopathic PhysiciansInternal MedicineInterventional Cardiology
Provider Identifiers
StateIdentifier IDID TypeIssuer
NY00757855Medicaid
87A611Medicare ID - Type Unspecified
NY00757855Medicaid