Provider Demographics
NPI:1821246372
Name:RUPOLO, MARIA T (LPN)
Entity Type:Individual
Prefix:
First Name:MARIA
Middle Name:T
Last Name:RUPOLO
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 1:6 SETTLER AVE
Mailing Address - Street 2:
Mailing Address - City:CORAM
Mailing Address - State:NY
Mailing Address - Zip Code:11727-2118
Mailing Address - Country:US
Mailing Address - Phone:631-928-9110
Mailing Address - Fax:
Practice Address - Street 1:1 RABRO DR
Practice Address - Street 2:
Practice Address - City:HAUPPAUGE
Practice Address - State:NY
Practice Address - Zip Code:11788-4270
Practice Address - Country:US
Practice Address - Phone:631-234-2000
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2008-09-08
Last Update Date:2008-09-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY074844-1164W00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes164W00000XNursing Service ProvidersLicensed Practical Nurse