Provider Demographics
NPI:1184935561
Name:LUPOW, DIANE (MS OTR/L)
Entity type:Individual
Prefix:MS
First Name:DIANE
Middle Name:
Last Name:LUPOW
Suffix:
Gender:F
Credentials:MS OTR/L
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:150 W 51ST ST
Mailing Address - Street 2:#824
Mailing Address - City:NEW YORK
Mailing Address - State:NY
Mailing Address - Zip Code:10019-6836
Mailing Address - Country:US
Mailing Address - Phone:212-842-0123
Mailing Address - Fax:
Practice Address - Street 1:20 BERGEN ST
Practice Address - Street 2:
Practice Address - City:BROOKLYN
Practice Address - State:NY
Practice Address - Zip Code:11201-6302
Practice Address - Country:US
Practice Address - Phone:718-625-3939
Practice Address - Fax:718-625-1456
Is Sole Proprietor?:No
Enumeration Date:2010-06-30
Last Update Date:2010-06-30
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY012240-1174400000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes174400000XOther Service ProvidersSpecialist