Healthcare Provider Details

I. General information

NPI: 1467446351
Provider Name (Legal Business Name): DAVID NUPP, P.T., P.C.
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 09/07/2005
Last Update Date: 03/17/2015
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

14 APPLETREE LN
LEVITTOWN NY
11756-2206
US

IV. Provider business mailing address

14 APPLETREE LN
LEVITTOWN NY
11756-2206
US

V. Phone/Fax

Practice location:
  • Phone: 516-728-1106
  • Fax:
Mailing address:
  • Phone: 516-728-1106
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code261QP2000X
TaxonomyPhysical Therapy Clinic/Center
License Number0036281
License Number StateNY

VIII. Authorized Official

Name: MR. DAVID PAUL NUPP
Title or Position: PRESIDENT
Credential: PT
Phone: 516-728-1106