Provider Demographics
NPI:1528009206
Name:RUPOLO, DASHURIJE (PA)
Entity Type:Individual
Prefix:MRS
First Name:DASHURIJE
Middle Name:
Last Name:RUPOLO
Suffix:
Gender:F
Credentials:PA
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:60 ROBINSON AVE
Mailing Address - Street 2:
Mailing Address - City:EAST PATCHOGUE
Mailing Address - State:NY
Mailing Address - Zip Code:11772-4842
Mailing Address - Country:US
Mailing Address - Phone:917-519-2102
Mailing Address - Fax:
Practice Address - Street 1:101 HOSPITAL ROAD
Practice Address - Street 2:MEDICAL CENTER
Practice Address - City:PATCHOGUE
Practice Address - State:NY
Practice Address - Zip Code:11772
Practice Address - Country:US
Practice Address - Phone:631-687-2953
Practice Address - Fax:610-617-6280
Is Sole Proprietor?:No
Enumeration Date:2006-06-10
Last Update Date:2018-11-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY0090121363A00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363A00000XPhysician Assistants & Advanced Practice Nursing ProvidersPhysician Assistant
Provider Identifiers
StateIdentifier IDID TypeIssuer
Q13623Medicare UPIN
NY536021Medicare ID - Type Unspecified