# LISA M. CAMPANELLA-COPPO, MD FUNCTIONAL MEDICINE & WELLNESS, PC

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- **Entity:** Organization
- **Status:** Active
- **Other names:** Functional Medicine and Wellness, PC
- **Organization subpart:** No

## Provider details

- **NPI number:** 1851072037
- **Authorized official:** DR. LISA MARIE CAMPANELLA-COPPO MD (OWNER)
- **Authorized official phone:** (551) 316-7740

## Contact information

- **Practice address:** 504 HAMBURG TPKE STE 202B, WAYNE, NJ 07470-2011
- **Practice address phone:** (551) 316-7740
- **Mailing address:** 637 WYCKOFF AVE STE 383, WYCKOFF, NJ 07481-1438
- **Mailing address phone:** (551) 316-7740

## Taxonomy

| Code | Description | License number | State | Primary |
| --- | --- | --- | --- | --- |
| 208D00000X | General Practice Physician | — | NULL | Yes |
| 208D00000X | General Practice Physician | — | — | Yes |

## Other

- **Enumeration date:** 07/31/2023
- **Last updated:** 07/31/2023