MEDICARE: VICTORIA LUPYNOS, INC.

Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

#	Taxonomy Code	Taxonomy	License Number	License Number State
1	252Y00000X	Early Intervention Provider Agency	022661-1	NY

General Provider Information

NPI Number	:	1699220186
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	VICTORIA LUPYNOS, INC.

Provider Business Mailing Address
First Line	:	2615 AVENUE W
Second Line	:
City	:	BROOKLYN
State	:	NY
Zip	:	11229-5041
Country	:	US
Telephone Number	:
Fax Number	:

Provider Business Practice Location Address
First Line	:	2615 AVENUE W
Second Line	:
City	:	BROOKLYN
State	:	NY
Zip	:	11229-5041
Country	:	US
Telephone Number	:	917-669-9318
Fax Number	:

Authorized Official
Title or Position	:	SLP-CCC, TSSLD-BEA
Name	:	VICTORIA LUPYNOS
Credential	:
Telephone Number	:	917-669-9318

Provider Enumeration Date	:	08/24/2016
Last Update Date	:	08/24/2016

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