Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
Y | 213ES0131X | Foot Surgery | 65006315 | NY |
NPI | 1083817126 |
---|---|
Provider Name | Dr. John Carlo Lupoli |
First Address | Flushing, NY 11358-1131 |
Second Address | Brooklyn, NY 11209-7104 |
Gender | M |
NPI Entity type | Individual |
Is Sole Proprietor | No |
Is Organization Subpart | N/A |
Enumeration Date | 07/06/2007 |
Last Update Date | 17/07/2009 |