Provider Demographics
NPI:1972566362
Name:COPPOLA, DANIELLE MARIE (ATC)
Entity type:Individual
Prefix:
First Name:DANIELLE
Middle Name:MARIE
Last Name:COPPOLA
Suffix:
Gender:F
Credentials:ATC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:22 CATHERINE ST
Mailing Address - Street 2:
Mailing Address - City:ROCHELLE PARK
Mailing Address - State:NJ
Mailing Address - Zip Code:07662-3302
Mailing Address - Country:US
Mailing Address - Phone:201-493-3660
Mailing Address - Fax:
Practice Address - Street 1:238 VAN BUREN ST
Practice Address - Street 2:
Practice Address - City:NEWARK
Practice Address - State:NJ
Practice Address - Zip Code:07105-2512
Practice Address - Country:US
Practice Address - Phone:973-418-8141
Practice Address - Fax:
Is Sole Proprietor?:Not Answered
Enumeration Date:2006-04-08
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NJ25MT001223002255A2300X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes2255A2300XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersSpecialist/TechnologistAthletic Trainer