Provider Demographics
NPI:1952400012
Name:KUPETSKY, ERINE ALLISON (DO)
Entity type:Individual
Prefix:
First Name:ERINE
Middle Name:ALLISON
Last Name:KUPETSKY
Suffix:
Gender:F
Credentials:DO
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1 BECCA WAY
Mailing Address - Street 2:
Mailing Address - City:ALLENTOWN
Mailing Address - State:NJ
Mailing Address - Zip Code:08501-2100
Mailing Address - Country:US
Mailing Address - Phone:609-947-3786
Mailing Address - Fax:
Practice Address - Street 1:638 LAWRENCEVILLE RD
Practice Address - Street 2:
Practice Address - City:LAWRENCEVILLE
Practice Address - State:NJ
Practice Address - Zip Code:08648-4208
Practice Address - Country:US
Practice Address - Phone:609-337-7643
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2006-09-22
Last Update Date:2023-02-17
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MI5101017085207N00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207N00000XAllopathic & Osteopathic PhysiciansDermatology
Provider Identifiers
StateIdentifier IDID TypeIssuer
MI5101017085OtherSTATE LICENSE