Healthcare Provider Details

I. General information

NPI: 1558708479
Provider Name (Legal Business Name): JOSEPH L KUPPELMEYER L.AC
Entity Type: Individual
Gender: Male
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 06/01/2013
Last Update Date: 10/05/2020
Certification Date: 10/05/2020
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1784 HEMPSTEAD TPKE
EAST MEADOW NY
11554-1022
US

IV. Provider business mailing address

300 WINSTON DR APT 615
CLIFFSIDE PARK NJ
07010-3213
US

V. Phone/Fax

Practice location:
  • Phone: 516-512-9855
  • Fax:
Mailing address:
  • Phone: 516-287-9710
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code171100000X
TaxonomyAcupuncturist
License Number005008
License Number StateNY

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: