Provider Demographics
NPI:1932109170
Name:KOPPEL, TODD S (MD)
Entity type:Individual
Prefix:DR
First Name:TODD
Middle Name:S
Last Name:KOPPEL
Suffix:
Gender:M
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
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Other - Credentials:
Mailing Address - Street 1:80 RIVERSIDE BLVD APT 11L
Mailing Address - Street 2:
Mailing Address - City:NEW YORK
Mailing Address - State:NY
Mailing Address - Zip Code:10069-0312
Mailing Address - Country:US
Mailing Address - Phone:973-473-5752
Mailing Address - Fax:973-473-2459
Practice Address - Street 1:1033 CLIFTON AVE STE 209
Practice Address - Street 2:
Practice Address - City:CLIFTON
Practice Address - State:NJ
Practice Address - Zip Code:07013-3525
Practice Address - Country:US
Practice Address - Phone:973-473-5752
Practice Address - Fax:973-473-2459
Is Sole Proprietor?:No
Enumeration Date:2005-07-29
Last Update Date:2025-12-15
Deactivation Date:
Deactivation Code:
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Provider Licenses
StateLicense IDTaxonomies
NY201176207LP2900X
NJ65665207LP2900X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207LP2900XAllopathic & Osteopathic PhysiciansAnesthesiologyPain Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
NY01744398Medicaid
NJ7378408Medicaid
NJ901452Medicare ID - Type Unspecified
NY74A39Medicare ID - Type Unspecified
NY01744398Medicaid