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General NPI Number Information
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NPI Number | 1609170364
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Entity Type | Individual
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Provider Name | MR. BENJAMIN W LUPIA
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Gender | Male
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Dates
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Enumeration Date | 01/10/2011
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Last Update Date | 01/10/2011
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Provider Practice Location Address
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Address Line | 300 PANTIGO PL SUITE 112
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City | EAST HAMPTON
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State | NY
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Zip | 11937-2684
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Country | US
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Telephone | 631-329-1828
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Fax | 631-329-1829
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Provider Business Mailing Address
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Address Line | 300 PANTIGO PL SUITE 112
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City | EAST HAMPTON
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State | NY
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Zip | 11937-2684
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Country | US
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Telephone | 631-329-1828
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Fax | 631-329-1829
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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 | 225200000X
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Taxonomy Name | Physical Therapy Assistant
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License Number | 006503-1
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License Number State | NY
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