Provider Demographics
NPI:1306829262
Name:LUPOWITZ, MARTIN DAVID (DC)
Entity Type:Individual
Prefix:DR
First Name:MARTIN
Middle Name:DAVID
Last Name:LUPOWITZ
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 1:13 SUOMINEN LN
Mailing Address - Street 2:
Mailing Address - City:ULSTER PARK
Mailing Address - State:NY
Mailing Address - Zip Code:12487-5343
Mailing Address - Country:US
Mailing Address - Phone:845-626-2500
Mailing Address - Fax:888-972-4614
Practice Address - Street 1:2919 LUCAS TPKE
Practice Address - Street 2:
Practice Address - City:ACCORD
Practice Address - State:NY
Practice Address - Zip Code:12404-5633
Practice Address - Country:US
Practice Address - Phone:845-626-2500
Practice Address - Fax:888-972-4614
Is Sole Proprietor?:Yes
Enumeration Date:2005-11-23
Last Update Date:2023-05-01
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NYX006669111N00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes111N00000XChiropractic ProvidersChiropractor
Provider Identifiers
StateIdentifier IDID TypeIssuer
U33865Medicare UPIN
X48122Medicare ID - Type Unspecified