Coppernoll Medical Practice PLLC

Primary specialty

Family Medicine PhysicianTaxonomy code 207Q00000X

Legal business name

COPPERNOLL MEDICAL PRACTICE PLLC

Practice address

101 Madison Ave
Wampsville, NY 13163-7777

Phone

(315) 761-6770

NPI assigned

Jun 24, 2014

Organization subpart

No

Registry information is reported by the provider to CMS and is not verified. About this source

Authorized official

Name

Randolph L Snow, DO

Title

Owner

Phone

(315) 761-6770

Specialties & licenses 2

Addresses

The complete NPPES record for this NPI in the NPI Registry API format.

{
    "created_epoch": "1403568000000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1414108800000",
    "number": "1750796173",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "101 MADISON AVE",
            "city": "WAMPSVILLE",
            "state": "NY",
            "postal_code": "131637777",
            "telephone_number": "315-761-6770"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "101 MADISON AVE",
            "city": "WAMPSVILLE",
            "state": "NY",
            "postal_code": "131637777",
            "telephone_number": "315-761-6770"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "COPPERNOLL MEDICAL PRACTICE PLLC",
        "organizational_subpart": "NO",
        "enumeration_date": "2014-06-24",
        "last_updated": "2014-10-24",
        "status": "A",
        "authorized_official_last_name": "SNOW",
        "authorized_official_first_name": "RANDOLPH",
        "authorized_official_middle_name": "L",
        "authorized_official_title_or_position": "OWNER",
        "authorized_official_telephone_number": "315-761-6770",
        "authorized_official_credential": "DO"
    },
    "taxonomies": [
        {
            "code": "207Q00000X",
            "taxonomy_group": "193200000X MULTI-SPECIALTY GROUP",
            "desc": "Family Medicine",
            "state": null,
            "license": null,
            "primary": true
        },
        {
            "code": "208D00000X",
            "taxonomy_group": "193200000X MULTI-SPECIALTY GROUP",
            "desc": "General Practice",
            "state": null,
            "license": null,
            "primary": false
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

• Kimberly Centore, LCSW
• Susan Chlebowski, M.D.
• Taylor Ann Christensen
• Sandra Lee Conklin, REGISTERED NURSE
• Teisha Marie Cook, LCSW
• County of Madison Mental Health Department
• Deborah Crumbie-Delic
• Edwina E Davies
• Martha Ann Devine, LMSW
• Norma Teresa Dipietro, LCSW

• Family Medicine Physician in Wampsville, NY
• Providers in Wampsville, NY by specialty
• Family Medicine Physician in New York

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Oct 24, 2014; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
• National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.

Verify at the official NPI Registry.