Provider Demographics
NPI:1922104652
Name:ZUPPA, ANGELO (PT, DPT)
Entity Type:Individual
Prefix:DR
First Name:ANGELO
Middle Name:
Last Name:ZUPPA
Suffix:
Gender:M
Credentials:PT, DPT
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:105 LAKE HILL RD
Mailing Address - Street 2:SUITE 4
Mailing Address - City:BURNT HILLS
Mailing Address - State:NY
Mailing Address - Zip Code:12027-9507
Mailing Address - Country:US
Mailing Address - Phone:518-952-7780
Mailing Address - Fax:888-370-2441
Practice Address - Street 1:105 LAKE HILL RD
Practice Address - Street 2:SUITE 4
Practice Address - City:BURNT HILLS
Practice Address - State:NY
Practice Address - Zip Code:12027-9507
Practice Address - Country:US
Practice Address - Phone:518-952-7780
Practice Address - Fax:888-370-2441
Is Sole Proprietor?:No
Enumeration Date:2006-09-16
Last Update Date:2013-04-12
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY0274742251X0800X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes2251X0800XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical TherapistOrthopedic
Provider Identifiers
StateIdentifier IDID TypeIssuer
NYJ400010677Medicare PIN