Individual
JOSHU E. COPPOLA
Active
Sole proprietor
No
Provider details
NPI number
Gender
Man
Credential
P.A.
Contact information
Practice address
5100 W TAFT RD, SUITE 1P, LIVERPOOL, NY 13088-3807
(315) 452-2829
(315) 452-2870
Mailing address
611 SKYVIEW TER, SYRACUSE, NY 13219-2871
(518) 201-4003
(315) 452-2870
Taxonomy
Speciality
Code
Description
License number
State
363A00000X
Physician Assistant
011563
NY
363AM0700X
Medical Physician Assistant
Primary
011563
NY
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
03316910
—
NY
Enumeration date
10/20/2006
Last updated
06/02/2021
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