Provider Demographics
NPI:1396186631
Name:JUPIN, ZACHARY J (PA-C)
Entity Type:Individual
Prefix:
First Name:ZACHARY
Middle Name:J
Last Name:JUPIN
Suffix:
Gender:M
Credentials:PA-C
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:220 ROUTE 12
Mailing Address - Street 2:
Mailing Address - City:GROTON
Mailing Address - State:CT
Mailing Address - Zip Code:06340-3414
Mailing Address - Country:US
Mailing Address - Phone:860-446-6137
Mailing Address - Fax:
Practice Address - Street 1:220 ROUTE 12
Practice Address - Street 2:
Practice Address - City:GROTON
Practice Address - State:CT
Practice Address - Zip Code:06340-3414
Practice Address - Country:US
Practice Address - Phone:860-446-6137
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2013-07-16
Last Update Date:2015-10-15
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
PAMA056193363AM0700X
CT003328363AM0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363AM0700XPhysician Assistants & Advanced Practice Nursing ProvidersPhysician AssistantMedical