Healthcare Provider Details

I. General information

NPI: 1083534440
Provider Name (Legal Business Name): TRINITY KUPE MSC, LAPC
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 07/16/2026
Last Update Date: 07/16/2026
Certification Date: 07/16/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

121 MOOSIC RD
OLD FORGE PA
18518-2082
US

IV. Provider business mailing address

121 MOOSIC RD
OLD FORGE PA
18518-2082
US

V. Phone/Fax

Practice location:
  • Phone: 570-342-8434
  • Fax:
Mailing address:
  • Phone: 570-342-8434
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code101Y00000X
TaxonomyCounselor
License NumberAPC002424
License Number StatePA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: