Provider Demographics
NPI:1952435760
Name:CHUPAK, CAROL ANNE (NP-C)
Entity type:Individual
Prefix:MS
First Name:CAROL ANNE
Middle Name:
Last Name:CHUPAK
Suffix:
Gender:F
Credentials:NP-C
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:277 FOREST AVE
Mailing Address - Street 2:
Mailing Address - City:PARAMUS
Mailing Address - State:NJ
Mailing Address - Zip Code:07652-5428
Mailing Address - Country:US
Mailing Address - Phone:201-986-1881
Mailing Address - Fax:201-986-1871
Practice Address - Street 1:277 FOREST AVE
Practice Address - Street 2:
Practice Address - City:PARAMUS
Practice Address - State:NJ
Practice Address - Zip Code:07652-5428
Practice Address - Country:US
Practice Address - Phone:201-986-1881
Practice Address - Fax:201-986-1871
Is Sole Proprietor?:No
Enumeration Date:2007-03-15
Last Update Date:2010-05-24
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NJ26NJ00055000363LA2200X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LA2200XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerAdult Health
Provider Identifiers
StateIdentifier IDID TypeIssuer
NJ26NJ00055000OtherLICENSE
NJ26NJ00055000OtherLICENSE