Provider Demographics
NPI:1699749713
Name:LUPENKO, EVE (MD)
Entity type:Individual
Prefix:
First Name:EVE
Middle Name:
Last Name:LUPENKO
Suffix:
Gender:F
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:160 CROSSWAYS PARK DR
Mailing Address - Street 2:
Mailing Address - City:WOODBURY
Mailing Address - State:NY
Mailing Address - Zip Code:11797-2028
Mailing Address - Country:US
Mailing Address - Phone:516-364-4200
Mailing Address - Fax:516-494-7031
Practice Address - Street 1:160 CROSSWAYS PARK DR
Practice Address - Street 2:
Practice Address - City:WOODBURY
Practice Address - State:NY
Practice Address - Zip Code:11797
Practice Address - Country:US
Practice Address - Phone:516-364-4200
Practice Address - Fax:516-494-7031
Is Sole Proprietor?:No
Enumeration Date:2006-02-15
Last Update Date:2018-09-05
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY200825207N00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207N00000XAllopathic & Osteopathic PhysiciansDermatology
Provider Identifiers
StateIdentifier IDID TypeIssuer
NY113019075OtherTAX ID NUMBER
NY113019075OtherTAX ID NUMBER
NYG90476Medicare UPIN