Provider Demographics
NPI:1487610796
Name:HUPART, PRESTON A (DO)
Entity type:Individual
Prefix:DR
First Name:PRESTON
Middle Name:A
Last Name:HUPART
Suffix:
Gender:M
Credentials:DO
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:120 FRANKLIN ST
Mailing Address - Street 2:
Mailing Address - City:JERSEY CITY
Mailing Address - State:NJ
Mailing Address - Zip Code:07307-2326
Mailing Address - Country:US
Mailing Address - Phone:201-216-9791
Mailing Address - Fax:201-216-1362
Practice Address - Street 1:120 FRANKLIN ST
Practice Address - Street 2:
Practice Address - City:JERSEY CITY
Practice Address - State:NJ
Practice Address - Zip Code:07307-2326
Practice Address - Country:US
Practice Address - Phone:201-216-9791
Practice Address - Fax:201-216-1362
Is Sole Proprietor?:No
Enumeration Date:2006-04-25
Last Update Date:2023-08-30
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NJ25MB06206400207RC0000X, 207RI0011X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207RI0011XAllopathic & Osteopathic PhysiciansInternal MedicineInterventional Cardiology
No207RC0000XAllopathic & Osteopathic PhysiciansInternal MedicineCardiovascular Disease
Provider Identifiers
StateIdentifier IDID TypeIssuer
NJ6532209Medicaid
NJ6532209Medicaid
NJ060062972Medicare PIN
NJ685358Medicare PIN