Provider Demographics
NPI:1407349954
Name:SUPINA, JOSEPH J SR
Entity Type:Individual
Prefix:
First Name:JOSEPH
Middle Name:J
Last Name:SUPINA
Suffix:SR
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 1:138 E MARKET ST
Mailing Address - Street 2:
Mailing Address - City:SANDUSKY
Mailing Address - State:OH
Mailing Address - Zip Code:44870-2506
Mailing Address - Country:US
Mailing Address - Phone:419-621-9377
Mailing Address - Fax:
Practice Address - Street 1:138 E MARKET ST
Practice Address - Street 2:
Practice Address - City:SANDUSKY
Practice Address - State:OH
Practice Address - Zip Code:44870-2506
Practice Address - Country:US
Practice Address - Phone:419-621-9377
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2018-06-10
Last Update Date:2018-06-10
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes175T00000XOther Service ProvidersPeer Specialist