Provider Demographics
NPI:1790134880
Name:LUPICA, ANNELISE MARIE (MD)
Entity Type:Individual
Prefix:DR
First Name:ANNELISE
Middle Name:MARIE
Last Name:LUPICA
Suffix:
Gender:F
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:229 W 116TH ST APT 5A
Mailing Address - Street 2:
Mailing Address - City:NEW YORK
Mailing Address - State:NY
Mailing Address - Zip Code:10026-2799
Mailing Address - Country:US
Mailing Address - Phone:818-720-9655
Mailing Address - Fax:
Practice Address - Street 1:3985 BROADWAY
Practice Address - Street 2:
Practice Address - City:NEW YORK
Practice Address - State:NY
Practice Address - Zip Code:10032
Practice Address - Country:US
Practice Address - Phone:917-305-6059
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2016-06-09
Last Update Date:2024-03-23
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY300156208000000X, 207PP0204X
CAA168984208000000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207PP0204XAllopathic & Osteopathic PhysiciansEmergency MedicinePediatric Emergency Medicine
Yes208000000XAllopathic & Osteopathic PhysiciansPediatrics