Provider Demographics
NPI:1033325766
Name:RUPNICK, ROBERT LOUIS (DC)
Entity Type:Individual
Prefix:DR
First Name:ROBERT
Middle Name:LOUIS
Last Name:RUPNICK
Suffix:
Gender:M
Credentials:DC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:110 NEW HWY
Mailing Address - Street 2:
Mailing Address - City:COMMACK
Mailing Address - State:NY
Mailing Address - Zip Code:11725-4232
Mailing Address - Country:US
Mailing Address - Phone:631-543-4644
Mailing Address - Fax:631-543-9183
Practice Address - Street 1:110 NEW HWY
Practice Address - Street 2:
Practice Address - City:COMMACK
Practice Address - State:NY
Practice Address - Zip Code:11725-4232
Practice Address - Country:US
Practice Address - Phone:631-543-4644
Practice Address - Fax:631-543-9183
Is Sole Proprietor?:Yes
Enumeration Date:2007-05-16
Last Update Date:2010-08-25
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NYX0037631111N00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes111N00000XChiropractic ProvidersChiropractor
Provider Identifiers
StateIdentifier IDID TypeIssuer
NY21826OtherVYTRA
NY0004640836OtherAETNA
NY0004640836OtherAETNA