Provider Demographics
NPI:1508745266
Name:LUPIS, RENEE
Entity type:Individual
Prefix:
First Name:RENEE
Middle Name:
Last Name:LUPIS
Suffix:
Gender:F
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:356 VETERANS MEMORIAL HWY STE 7
Mailing Address - Street 2:
Mailing Address - City:COMMACK
Mailing Address - State:NY
Mailing Address - Zip Code:11725-4332
Mailing Address - Country:US
Mailing Address - Phone:631-600-0306
Mailing Address - Fax:
Practice Address - Street 1:356 VETERANS MEMORIAL HWY STE 7
Practice Address - Street 2:
Practice Address - City:COMMACK
Practice Address - State:NY
Practice Address - Zip Code:11725-4332
Practice Address - Country:US
Practice Address - Phone:631-600-0306
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2025-08-28
Last Update Date:2025-08-28
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY026830225700000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225700000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersMassage Therapist