Provider Demographics
NPI:1073578316
Name:KRUPA, JOHN W III
Entity Type:Individual
Prefix:MR
First Name:JOHN
Middle Name:W
Last Name:KRUPA
Suffix:III
Gender:M
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:33 ALLEN RD
Mailing Address - Street 2:
Mailing Address - City:ROCKVILLE CENTRE
Mailing Address - State:NY
Mailing Address - Zip Code:11570-1212
Mailing Address - Country:US
Mailing Address - Phone:516-561-1694
Mailing Address - Fax:
Practice Address - Street 1:1204 JERICHO TPKE
Practice Address - Street 2:
Practice Address - City:NEW HYDE PARK
Practice Address - State:NY
Practice Address - Zip Code:11040-4607
Practice Address - Country:US
Practice Address - Phone:516-326-7899
Practice Address - Fax:516-326-7895
Is Sole Proprietor?:No
Enumeration Date:2006-04-19
Last Update Date:2008-04-21
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY8984225100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225100000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical Therapist
Provider Identifiers
StateIdentifier IDID TypeIssuer
NYQ5724QC451Medicare PIN