Provider Demographics
NPI:1508967746
Name:LUPICKI, MAREK ROBERT (MD)
Entity Type:Individual
Prefix:
First Name:MAREK
Middle Name:ROBERT
Last Name:LUPICKI
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 1:200 PERRINE RD
Mailing Address - Street 2:SUITE 211
Mailing Address - City:OLD BRIDGE
Mailing Address - State:NJ
Mailing Address - Zip Code:08857-2842
Mailing Address - Country:US
Mailing Address - Phone:732-553-1000
Mailing Address - Fax:732-553-1003
Practice Address - Street 1:200 PERRINE RD
Practice Address - Street 2:SUITE 211
Practice Address - City:OLD BRIDGE
Practice Address - State:NJ
Practice Address - Zip Code:08857-2842
Practice Address - Country:US
Practice Address - Phone:732-553-1000
Practice Address - Fax:732-553-1003
Is Sole Proprietor?:Yes
Enumeration Date:2006-09-26
Last Update Date:2007-10-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NJNJMA64530207R00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207R00000XAllopathic & Osteopathic PhysiciansInternal Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
NJ7162308Medicaid
NJ892784Medicare PIN
NJ7162308Medicaid