Provider Demographics
NPI:1558708479
Name:KUPPELMEYER, JOSEPH L (LAC)
Entity Type:Individual
Prefix:MR
First Name:JOSEPH
Middle Name:L
Last Name:KUPPELMEYER
Suffix:
Gender:M
Credentials:LAC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:300 WINSTON DR APT 615
Mailing Address - Street 2:
Mailing Address - City:CLIFFSIDE PARK
Mailing Address - State:NJ
Mailing Address - Zip Code:07010-3213
Mailing Address - Country:US
Mailing Address - Phone:516-287-9710
Mailing Address - Fax:
Practice Address - Street 1:1784 HEMPSTEAD TPKE
Practice Address - Street 2:
Practice Address - City:EAST MEADOW
Practice Address - State:NY
Practice Address - Zip Code:11554-1022
Practice Address - Country:US
Practice Address - Phone:516-512-9855
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2013-06-01
Last Update Date:2020-10-05
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY005008171100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes171100000XOther Service ProvidersAcupuncturist