MEDICARE: DR. BERNADETTE PUPILLA DPM

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	213E00000X	Podiatrist	N0048241	NY

General Provider Information

NPI Number	:	1891801494
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	DR. BERNADETTE PUPILLA DPM

Provider Business Mailing Address
First Line	:	5444 LITTLE NECK PKWY
Second Line	:
City	:	LITTLE NECK
State	:	NY
Zip	:	11362
Country	:	US
Telephone Number	:	718-631-8783
Fax Number	:	718-428-5310

Provider Business Practice Location Address
First Line	:	5444 LITTLE NECK PKWY
Second Line	:
City	:	LITTLE NECK
State	:	NY
Zip	:	11362
Country	:	US
Telephone Number	:	718-631-8783
Fax Number	:	718-428-5310

Authorized Official
Title or Position	:
Name	:
Credential	:
Telephone Number	:

Provider Enumeration Date	:	08/23/2006
Last Update Date	:	07/08/2007

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