Provider Demographics
NPI:1962670653
Name:LEONARD N CUPO, M.D., P.C.
Entity Type:Organization
Organization Name:LEONARD N CUPO, M.D., P.C.
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PRESIDENT
Authorized Official - Prefix:DR
Authorized Official - First Name:LEONARD
Authorized Official - Middle Name:NICHOLAS
Authorized Official - Last Name:CUPO
Authorized Official - Suffix:
Authorized Official - Credentials:MEDICAL DOCTOR
Authorized Official - Phone:808-599-8787
Mailing Address - Street 1:1319 S KING ST
Mailing Address - Street 2:
Mailing Address - City:HONOLULU
Mailing Address - State:HI
Mailing Address - Zip Code:96814-2341
Mailing Address - Country:US
Mailing Address - Phone:808-599-8787
Mailing Address - Fax:
Practice Address - Street 1:1319 S KING ST
Practice Address - Street 2:
Practice Address - City:HONOLULU
Practice Address - State:HI
Practice Address - Zip Code:96814-2341
Practice Address - Country:US
Practice Address - Phone:808-599-8787
Practice Address - Fax:808-599-7744
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2008-02-14
Last Update Date:2008-06-13
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
HIMD 8060261QM2500X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes261QM2500XAmbulatory Health Care FacilitiesClinic/CenterMedical Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
HI00666501Medicaid
HIH0000BDWVDMedicare PIN