Healthcare Provider Details

I. General information

NPI: 1386779296
Provider Name (Legal Business Name): SUNIL K. DHUPER M.D.
Entity Type: Individual
Gender: Male
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 02/22/2007
Last Update Date: 04/26/2021
Certification Date: 04/26/2021
Deactivation Date:
Reactivation Date:

III. Provider practice location address

8 TECHNOLOGY DRIVE
EAST SETAUKET NY
11733
US

IV. Provider business mailing address

47 RED GROUND ROAD
OLD WESTBURY NY
11568
US

V. Phone/Fax

Practice location:
  • Phone: 631-652-0122
  • Fax: 877-434-7939
Mailing address:
  • Phone: 516-967-1892
  • Fax: 877-434-7939

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code207R00000X
TaxonomyInternal Medicine Physician
License Number189320
License Number StateNY

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: