Basic Information
Provider Information | |||||||||
NPI: | 1912926825 | ||||||||
EntityType: | 1 | ||||||||
ReplacementNPI: |   | ||||||||
OrganizationName: |   | ||||||||
LastName: | COPELAND | ||||||||
FirstName: | MARCIA | ||||||||
MiddleName: | A. | ||||||||
NamePrefix: | DR. | ||||||||
NameSuffix: |   | ||||||||
Credential: | M.D. | ||||||||
OtherOrganizationName: |   | ||||||||
OtherOrganizationType: |   | ||||||||
OtherLastName: |   | ||||||||
OtherFirstName: |   | ||||||||
OtherMiddleName: |   | ||||||||
OtherNamePrefix: |   | ||||||||
OtherNameSuffix: |   | ||||||||
OtherCredential: |   | ||||||||
OtherLastNameType: |   | ||||||||
Mailing Information | |||||||||
Address1: | 10 COMMERCE DR | ||||||||
Address2: |   | ||||||||
City: | NEW ROCHELLE | ||||||||
State: | NY | ||||||||
PostalCode: | 108015214 | ||||||||
CountryCode: | US | ||||||||
TelephoneNumber: | 9146373510 | ||||||||
FaxNumber: | 9148190061 | ||||||||
Practice Location | |||||||||
Address1: | 29 E 29TH ST | ||||||||
Address2: |   | ||||||||
City: | BAYONNE | ||||||||
State: | NJ | ||||||||
PostalCode: | 070024654 | ||||||||
CountryCode: | US | ||||||||
TelephoneNumber: | 2018585000 | ||||||||
FaxNumber: |   | ||||||||
Other Information | |||||||||
ProviderEnumerationDate: | 07/19/2006 | ||||||||
LastUpdateDate: | 10/16/2009 | ||||||||
NPIDeactivationReasonCode: |   | ||||||||
NPIDeactivationDate: | 07/17/2007 | ||||||||
NPIReactivationDate: | 12/26/2007 | ||||||||
ProviderGenderCode: | F | ||||||||
AuthorizedOfficialLastName: |   | ||||||||
AuthorizedOfficialFirstName: |   | ||||||||
AuthorizedOfficialMiddleName: |   | ||||||||
AuthorizedOfficialTitleorPosition: |   | ||||||||
AuthorizedOfficialTelephone: |   | ||||||||
IsSoleProprietor: | N | ||||||||
IsOrganizationSubpart: |   | ||||||||
ParentOrganizationLBN: |   | ||||||||
AuthorizedOfficialNamePrefix: |   | ||||||||
AuthorizedOfficialNameSuffix: |   | ||||||||
AuthorizedOfficialCredential: |   | ||||||||
NPICertificationDate: |   |
Taxonomy Information
Taxonomy | License | State | Switch | TaxonomyGroup | TaxonomyType | TaxonomyClass | SubSpecialty | 207L00000X | 25MA06442700 | NJ | Y |   | Allopathic & Osteopathic Physicians | Anesthesiology |   |
ID Information
ID | Type | State | Issuer | Description | 7032609 | 05 | NJ |   | MEDICAID |