Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
Y | 207Y00000X | Otolaryngologist (ENT Doctor) | 043483 | CT |
N | 207YS0123X | Facial Plastic Surgeon | 236302 | NY |
NPI | 1932197852 |
---|---|
Provider Name | Howard David Stupak |
First Address | Westport, CT 06880-3307 |
Second Address | Westport, CT 06880-3307 |
Gender | M |
NPI Entity type | Individual |
Is Sole Proprietor | Yes |
Is Organization Subpart | N/A |
Enumeration Date | 13/10/2005 |
Last Update Date | 17/03/2018 |
IDENTIFIER | TYPE / CODE | IDENTIFIER STATE |
---|---|---|
L3924 | (02) |