Provider Demographics
NPI:1861589947
Name:HUPERT, NATHANIEL (MD)
Entity type:Individual
Prefix:
First Name:NATHANIEL
Middle Name:
Last Name:HUPERT
Suffix:
Gender:M
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:525 E68TH STREET
Mailing Address - Street 2:STARR 5
Mailing Address - City:NEW YORK
Mailing Address - State:NY
Mailing Address - Zip Code:10065-4872
Mailing Address - Country:US
Mailing Address - Phone:212-746-4071
Mailing Address - Fax:212-746-7481
Practice Address - Street 1:525 E68TH STREET
Practice Address - Street 2:STARR 5
Practice Address - City:NEW YORK
Practice Address - State:NY
Practice Address - Zip Code:10065-4872
Practice Address - Country:US
Practice Address - Phone:212-746-4071
Practice Address - Fax:212-746-4610
Is Sole Proprietor?:No
Enumeration Date:2006-10-09
Last Update Date:2020-08-27
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY218548207R00000X, 208M00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes208M00000XAllopathic & Osteopathic PhysiciansHospitalist
No207R00000XAllopathic & Osteopathic PhysiciansInternal Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
NY02134825Medicaid
NY001L31Medicaid
NY02134825Medicaid