Provider Demographics
NPI:1518308345
Name:RUPP, MARIE JOSEPHINE (LPN)
Entity Type:Individual
Prefix:
First Name:MARIE
Middle Name:JOSEPHINE
Last Name:RUPP
Suffix:
Gender:F
Credentials:LPN
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:168 MOUNT SINAI CORAM RD
Mailing Address - Street 2:
Mailing Address - City:CORAM
Mailing Address - State:NY
Mailing Address - Zip Code:11727-2202
Mailing Address - Country:US
Mailing Address - Phone:631-846-4235
Mailing Address - Fax:
Practice Address - Street 1:168 MOUNT SINAI CORAM RD
Practice Address - Street 2:
Practice Address - City:CORAM
Practice Address - State:NY
Practice Address - Zip Code:11727-2202
Practice Address - Country:US
Practice Address - Phone:631-846-4235
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2013-07-09
Last Update Date:2013-07-09
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY310785164W00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes164W00000XNursing Service ProvidersLicensed Practical Nurse