Individual
KELLY COPPOLA
Active
Sole proprietor
Yes
Provider details
NPI number
Gender
F
Contact information
Practice address
540 BORDENTOWN AVE, SOUTH AMBOY, NJ 08879-1546
(732) 720-1000
Mailing address
255 CLUBHOUSE DR, MIDDLETOWN, NJ 07748-1324
Taxonomy
Speciality
Code
Description
License number
State
163WA0400X
Addiction (Substance Use Disorder) Registered Nurse
Primary
26NR13540100
NJ
Other
Enumeration date
01/10/2025
Last updated
01/10/2025
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