Basic Information
| Provider Information | |||||||||
| NPI: | 1932109170 | ||||||||
| EntityType: | 1 | ||||||||
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| OrganizationName: | |||||||||
| LastName: | KOPPEL | ||||||||
| FirstName: | TODD | ||||||||
| MiddleName: | S. | ||||||||
| NamePrefix: | DR. | ||||||||
| NameSuffix: | |||||||||
| Credential: | MD | ||||||||
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| Mailing Information | |||||||||
| Address1: | 118 N BEDFORD RD | ||||||||
| Address2: | SUITE 200 | ||||||||
| City: | MOUNT KISCO | ||||||||
| State: | NY | ||||||||
| PostalCode: | 105492553 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 9146668866 | ||||||||
| FaxNumber: | 9146666777 | ||||||||
| Practice Location | |||||||||
| Address1: | 721 CLIFTON AVE | ||||||||
| Address2: | SUITE 2D | ||||||||
| City: | CLIFTON | ||||||||
| State: | NJ | ||||||||
| PostalCode: | 070131880 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 9734735752 | ||||||||
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| Other Information | |||||||||
| ProviderEnumerationDate: | 07/29/2005 | ||||||||
| LastUpdateDate: | 05/20/2011 | ||||||||
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| ProviderGenderCode: | M | ||||||||
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| IsSoleProprietor: | N | ||||||||
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Taxonomy Information
| Taxonomy | License | State | Switch | TaxonomyGroup | TaxonomyType | TaxonomyClass | SubSpecialty | 207LP2900X | 65665 | NJ | Y | Allopathic & Osteopathic Physicians | Anesthesiology | Pain Medicine | 207LP2900X | 201176 | NY | N | Allopathic & Osteopathic Physicians | Anesthesiology | Pain Medicine |
ID Information
| ID | Type | State | Issuer | Description | 01744398 | 05 | NY | MEDICAID | 7378408 | 05 | NJ | MEDICAID |