Provider Demographics
NPI:1881910842
Name:LUPON, JORDON
Entity type:Individual
Prefix:
First Name:JORDON
Middle Name:
Last Name:LUPON
Suffix:
Gender:M
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:82 KEMP AVE
Mailing Address - Street 2:
Mailing Address - City:FAIR HAVEN
Mailing Address - State:NJ
Mailing Address - Zip Code:07704-3530
Mailing Address - Country:US
Mailing Address - Phone:732-673-4689
Mailing Address - Fax:
Practice Address - Street 1:82 KEMP AVE
Practice Address - Street 2:
Practice Address - City:FAIR HAVEN
Practice Address - State:NJ
Practice Address - Zip Code:07704-3530
Practice Address - Country:US
Practice Address - Phone:732-673-4689
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2010-04-15
Last Update Date:2010-04-15
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101Y00000XBehavioral Health & Social Service ProvidersCounselor