Healthcare Provider Details

I. General information

NPI: 1417538109
Provider Name (Legal Business Name): NOAH VINCENZO LUPICA MD
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 04/15/2021
Last Update Date: 06/25/2026
Certification Date: 06/25/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

644 W PUTNAM AVE # 203
GREENWICH CT
06830-6088
US

IV. Provider business mailing address

644 W PUTNAM AVE # 203
GREENWICH CT
06830-6088
US

V. Phone/Fax

Practice location:
  • Phone: 203-661-6430
  • Fax: 203-661-2597
Mailing address:
  • Phone: 203-661-6430
  • Fax: 203-661-2597

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code208000000X
TaxonomyPediatrics Physician
License NumberCMD20062
License Number StateRI
# 2
Primary TaxonomyN
Taxonomy Code208000000X
TaxonomyPediatrics Physician
License Number343022
License Number StateNY
# 3
Primary TaxonomyN
Taxonomy Code208000000X
TaxonomyPediatrics Physician
License Number83992
License Number StateCT

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: