Provider Demographics
NPI:1669579439
Name:LUPICKI, LUCYNA KRYSTYNA (MD)
Entity type:Individual
Prefix:
First Name:LUCYNA
Middle Name:KRYSTYNA
Last Name:LUPICKI
Suffix:
Gender:F
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:200 PERRINE RD
Mailing Address - Street 2:SUITE 211
Mailing Address - City:OLD BRIDGE
Mailing Address - State:NJ
Mailing Address - Zip Code:08857-2842
Mailing Address - Country:US
Mailing Address - Phone:732-553-1000
Mailing Address - Fax:732-553-1003
Practice Address - Street 1:200 PERRINE RD
Practice Address - Street 2:SUITE 211
Practice Address - City:OLD BRIDGE
Practice Address - State:NJ
Practice Address - Zip Code:08857-2842
Practice Address - Country:US
Practice Address - Phone:732-553-1000
Practice Address - Fax:732-553-1003
Is Sole Proprietor?:Yes
Enumeration Date:2006-09-20
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NJMA067106208100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes208100000XAllopathic & Osteopathic PhysiciansPhysical Medicine & Rehabilitation
Provider Identifiers
StateIdentifier IDID TypeIssuer
NJ7612605Medicaid
NJLU010092Medicare ID - Type Unspecified
NJ7612605Medicaid