Provider Demographics
NPI:1306911680
Name:HUPART, MARK ELLIOTT (DPM)
Entity type:Individual
Prefix:DR
First Name:MARK
Middle Name:ELLIOTT
Last Name:HUPART
Suffix:
Gender:M
Credentials:DPM
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:2123 E 70TH ST
Mailing Address - Street 2:
Mailing Address - City:BROOKLYN
Mailing Address - State:NY
Mailing Address - Zip Code:11234
Mailing Address - Country:US
Mailing Address - Phone:718-241-5764
Mailing Address - Fax:718-241-5764
Practice Address - Street 1:2123 E 70TH ST
Practice Address - Street 2:
Practice Address - City:BROOKLYN
Practice Address - State:NY
Practice Address - Zip Code:11234-6101
Practice Address - Country:US
Practice Address - Phone:718-241-2000
Practice Address - Fax:718-241-2000
Is Sole Proprietor?:Yes
Enumeration Date:2006-11-21
Last Update Date:2018-01-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NYN004686213E00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes213E00000XPodiatric Medicine & Surgery Service ProvidersPodiatrist
Provider Identifiers
StateIdentifier IDID TypeIssuer
NY06719OtherMEDICARE GHI
NY1306911680OtherMEDICARE
NY01180363Medicaid
NY1306911680Medicaid