Provider Demographics
NPI:1851093462
Name:RUPERT, DEBORAH DOROTHY (STUDENT HEALTH CARE)
Entity Type:Individual
Prefix:MS
First Name:DEBORAH
Middle Name:DOROTHY
Last Name:RUPERT
Suffix:
Gender:F
Credentials:STUDENT HEALTH CARE
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:4 DONALD DR
Mailing Address - Street 2:
Mailing Address - City:KINGS PARK
Mailing Address - State:NY
Mailing Address - Zip Code:11754-4704
Mailing Address - Country:US
Mailing Address - Phone:206-930-4152
Mailing Address - Fax:
Practice Address - Street 1:101 NICOLLS RD
Practice Address - Street 2:
Practice Address - City:STONY BROOK
Practice Address - State:NY
Practice Address - Zip Code:11794-4704
Practice Address - Country:US
Practice Address - Phone:631-444-9547
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2023-03-20
Last Update Date:2023-03-21
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes390200000XStudent, Health CareStudent in an Organized Health Care Education/Training Program