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General NPI Number Information
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NPI Number | 1184268690
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Entity Type | Individual
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Provider Name | RICHARD A LUPO JR.
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Gender | Male
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Dates
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Enumeration Date | 10/29/2019
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Last Update Date | 10/29/2019
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Provider Practice Location Address
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Address Line | 1 HEALTHY WAY
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City | OCEANSIDE
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State | NY
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Zip | 11572-1551
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Country | US
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Telephone | 877-768-8462
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Fax |
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Provider Business Mailing Address
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Address Line | 19 PARK CIR
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City | NESCONSET
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State | NY
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Zip | 11767-3024
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Country | US
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Telephone | 631-766-6875
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Fax |
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Authorized Official
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Title or Position |
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Name |
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Credential |
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Telephone |
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 363A00000X
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Taxonomy Name | Physician Assistant
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License Number | 024356
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License Number State | NY
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