Provider Demographics
NPI:1861538498
Name:SAMUEL LUPIN MD PC
Entity type:Organization
Organization Name:SAMUEL LUPIN MD PC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PRESIDENT
Authorized Official - Prefix:DR
Authorized Official - First Name:SAMUEL
Authorized Official - Middle Name:
Authorized Official - Last Name:LUPIN
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:845-356-9433
Mailing Address - Street 1:20 CHARLOTTE DR
Mailing Address - Street 2:
Mailing Address - City:SPRING VALLEY
Mailing Address - State:NY
Mailing Address - Zip Code:10977-1126
Mailing Address - Country:US
Mailing Address - Phone:718-360-9370
Mailing Address - Fax:917-621-3151
Practice Address - Street 1:3131 KINGS HWY
Practice Address - Street 2:SUITE A7
Practice Address - City:BROOKLYN
Practice Address - State:NY
Practice Address - Zip Code:11234-2644
Practice Address - Country:US
Practice Address - Phone:718-360-9370
Practice Address - Fax:917-621-3151
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2007-01-30
Last Update Date:2009-10-28
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY138014174400000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes174400000XOther Service ProvidersSpecialistGroup - Single Specialty