Lisa M. Campanella-Coppo, MD Functional Medicine & Wellness, PC

Primary specialty

General Practice PhysicianTaxonomy code 208D00000X

Legal business name

LISA M. CAMPANELLA-COPPO, MD FUNCTIONAL MEDICINE & WELLNESS, PC

Doing business as

Functional Medicine and Wellness, PC

Practice address

504 Hamburg Tpke Ste 202B
Wayne, NJ 07470-2011

Phone

(551) 316-7740

NPI assigned

Jul 31, 2023

Last updated

Jul 31, 2023By the provider in NPPES

Organization subpart

No

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

Authorized official

Name

Dr. Lisa Marie Campanella-Coppo, MDNPI 1720180623

Title

Owner

Phone

(551) 316-7740

Specialties & licenses 1

Addresses

Other names 1

• Functional Medicine and Wellness, PC Doing business as

Locations

Practitioners 1

Individual providers connected to this organization through Medicare benefit reassignment, Care Compare group membership or National Provider Directory roles, and the practitioner matching its NPPES authorized official.

• Lisa Campanella-Coppo, MD

  • Emergency Medicine Physician
  • Bennington, VT
  • NPI 1720180623
  NPD Authorized official

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

{
    "created_epoch": "1690761600000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1690761600000",
    "number": "1851072037",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "637 WYCKOFF AVE STE 383",
            "city": "WYCKOFF",
            "state": "NJ",
            "postal_code": "074811438",
            "telephone_number": "551-316-7740"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "504 HAMBURG TPKE STE 202B",
            "city": "WAYNE",
            "state": "NJ",
            "postal_code": "074702011",
            "telephone_number": "551-316-7740"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "LISA M. CAMPANELLA-COPPO, MD FUNCTIONAL MEDICINE & WELLNESS, PC",
        "organizational_subpart": "NO",
        "enumeration_date": "2023-07-31",
        "last_updated": "2023-07-31",
        "certification_date": "2023-07-29",
        "status": "A",
        "authorized_official_last_name": "CAMPANELLA-COPPO",
        "authorized_official_first_name": "LISA",
        "authorized_official_middle_name": "MARIE",
        "authorized_official_title_or_position": "OWNER",
        "authorized_official_telephone_number": "551-316-7740",
        "authorized_official_name_prefix": "Dr.",
        "authorized_official_credential": "MD"
    },
    "taxonomies": [
        {
            "code": "208D00000X",
            "taxonomy_group": "193400000X SINGLE SPECIALTY  GROUP",
            "desc": "General Practice",
            "state": null,
            "license": null,
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": [
        {
            "organization_name": "Functional Medicine and Wellness, PC",
            "code": "3",
            "type": "Doing Business As"
        }
    ]
}

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• General Practice Physician in Wayne, NJ
• Providers in Wayne, NJ by specialty
• General Practice Physician in New Jersey

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Jul 31, 2023; 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.