Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
Y | 111NN1001X | Nutrition | 1883X-1 | NY |
NPI | 1184706236 |
---|---|
Provider Name | Dr. John G Rupolo |
First Address | Floral Park, NY 11001-2705 |
Second Address | Floral Park, NY 11001-2705 |
Gender | M |
NPI Entity type | Individual |
Is Sole Proprietor | No |
Is Organization Subpart | N/A |
Enumeration Date | 19/10/2006 |
Last Update Date | 13/11/2009 |
IDENTIFIER | TYPE / CODE | IDENTIFIER STATE |
---|---|---|
T51598 | (02) | NY |
X01701 | BLUE CROSS (01) | NY |