Provider Demographics
NPI:1952561854
Name:M. LUPOVICI, M.D., P.A.
Entity Type:Organization
Organization Name:M. LUPOVICI, M.D., P.A.
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OFFICE MANAGER
Authorized Official - Prefix:MRS
Authorized Official - First Name:MELISSA
Authorized Official - Middle Name:
Authorized Official - Last Name:LYON
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:609-448-7200
Mailing Address - Street 1:254 PRINCETON HIGHTSTOWN RD
Mailing Address - Street 2:
Mailing Address - City:EAST WINDSOR
Mailing Address - State:NJ
Mailing Address - Zip Code:08520-1402
Mailing Address - Country:US
Mailing Address - Phone:609-448-7200
Mailing Address - Fax:609-448-4607
Practice Address - Street 1:254 PRINCETON HIGHTSTOWN RD
Practice Address - Street 2:
Practice Address - City:EAST WINDSOR
Practice Address - State:NJ
Practice Address - Zip Code:08520-1402
Practice Address - Country:US
Practice Address - Phone:609-448-7200
Practice Address - Fax:609-448-4607
EIN:<UNAVAIL>
Is Organization Subpart?:Yes
Parent Organization LBN:M. LUPOVICI, M.D., P.A.
Parent Organization TIN:<UNAVAIL>
Enumeration Date:2008-06-13
Last Update Date:2016-05-05
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NJ34309207RG0100X
NJMAO34309207RG0300X
NJ25MA03738200207RH0003X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes207RG0100XAllopathic & Osteopathic PhysiciansInternal MedicineGastroenterologyGroup - Multi-Specialty
No207RG0300XAllopathic & Osteopathic PhysiciansInternal MedicineGeriatric MedicineGroup - Multi-Specialty
No207RH0003XAllopathic & Osteopathic PhysiciansInternal MedicineHematology & OncologyGroup - Multi-Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
NJ0830305Medicaid
NJ0666967013OtherCIGNA/SPECIALIST
NJ516050OtherAETNA/HMO
NJ4058986OtherAMERIHEALTH PPO
NJ0666967014OtherCIGNA PCP/PRIMARY CARE
NJ1543982OtherUNITED HEALTH CARE
NJ0107057000OtherAMERIHEALTH HMO
NJ4058986OtherAETNA/PPO
NJDR8706OtherOXFORD HEALTH
NJ1543982OtherUNITED HEALTH CARE
NJ4058986OtherAMERIHEALTH PPO