Provider Demographics
NPI:1841398641
Name:PUOPOLO, STEVEN M (MD)
Entity Type:Individual
Prefix:DR
First Name:STEVEN
Middle Name:M
Last Name:PUOPOLO
Suffix:
Gender:M
Credentials:MD
Other - Prefix:
Other - First Name:
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Other - Last Name:
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Mailing Address - Street 1:6 TECHNOLOGY DR STE 100
Mailing Address - Street 2:
Mailing Address - City:EAST SETAUKET
Mailing Address - State:NY
Mailing Address - Zip Code:11733-4079
Mailing Address - Country:US
Mailing Address - Phone:631-689-6698
Mailing Address - Fax:631-751-5548
Practice Address - Street 1:6 TECHNOLOGY DR STE 100
Practice Address - Street 2:
Practice Address - City:EAST SETAUKET
Practice Address - State:NY
Practice Address - Zip Code:11733-4079
Practice Address - Country:US
Practice Address - Phone:631-689-6698
Practice Address - Fax:631-751-5548
Is Sole Proprietor?:No
Enumeration Date:2006-09-20
Last Update Date:2019-03-18
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY213316207X00000X, 207XS0106X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207XS0106XAllopathic & Osteopathic PhysiciansOrthopaedic SurgeryHand Surgery
No207X00000XAllopathic & Osteopathic PhysiciansOrthopaedic Surgery
Provider Identifiers
StateIdentifier IDID TypeIssuer
NY002639545Medicaid
NYH93598Medicare UPIN