Provider Demographics
NPI:1720898802
Name:MATRA, ALYSSA COPPA (CNS)
Entity type:Individual
Prefix:MRS
First Name:ALYSSA
Middle Name:COPPA
Last Name:MATRA
Suffix:
Gender:F
Credentials:CNS
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1055 PLEASANTVILLE RD
Mailing Address - Street 2:
Mailing Address - City:BRIARCLIFF MANOR
Mailing Address - State:NY
Mailing Address - Zip Code:10510-1623
Mailing Address - Country:US
Mailing Address - Phone:914-479-2297
Mailing Address - Fax:
Practice Address - Street 1:530 E 74TH ST
Practice Address - Street 2:
Practice Address - City:NEW YORK
Practice Address - State:NY
Practice Address - Zip Code:10021-3459
Practice Address - Country:US
Practice Address - Phone:646-608-1635
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2025-01-10
Last Update Date:2025-01-10
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY713638163WX0200X, 364S00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes364S00000XPhysician Assistants & Advanced Practice Nursing ProvidersClinical Nurse Specialist
No163WX0200XNursing Service ProvidersRegistered NurseOncology