Provider Demographics
NPI:1194831958
Name:DUPITON, JEAN LOUIS MAX (MD)
Entity Type:Individual
Prefix:
First Name:JEAN LOUIS
Middle Name:MAX
Last Name:DUPITON
Suffix:
Gender:M
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:35 N TYSON AVE STE 100
Mailing Address - Street 2:
Mailing Address - City:FLORAL PARK
Mailing Address - State:NY
Mailing Address - Zip Code:11001-1469
Mailing Address - Country:US
Mailing Address - Phone:718-276-7935
Mailing Address - Fax:
Practice Address - Street 1:35 N TYSON AVE STE 100
Practice Address - Street 2:
Practice Address - City:FLORAL PARK
Practice Address - State:NY
Practice Address - Zip Code:11001-1469
Practice Address - Country:US
Practice Address - Phone:718-276-7935
Practice Address - Fax:347-233-4330
Is Sole Proprietor?:No
Enumeration Date:2006-08-22
Last Update Date:2023-06-27
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY216185207R00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207R00000XAllopathic & Osteopathic PhysiciansInternal Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
NY02045696Medicaid
NY02045696Medicaid
H10889Medicare UPIN
NY05903GMedicare ID - Type UnspecifiedGHI