Provider Demographics
NPI:1699751917
Name:PUPO, LOUIS O (MD)
Entity type:Individual
Prefix:DR
First Name:LOUIS
Middle Name:O
Last Name:PUPO
Suffix:
Gender:M
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:61 NEWTON SPARTA ROAD
Mailing Address - Street 2:
Mailing Address - City:NEWTON
Mailing Address - State:NJ
Mailing Address - Zip Code:07860
Mailing Address - Country:US
Mailing Address - Phone:973-726-7337
Mailing Address - Fax:973-579-3071
Practice Address - Street 1:61 NEWTON SPARTA ROAD
Practice Address - Street 2:
Practice Address - City:NEWTON
Practice Address - State:NJ
Practice Address - Zip Code:07860
Practice Address - Country:US
Practice Address - Phone:973-726-7337
Practice Address - Fax:973-579-3071
Is Sole Proprietor?:Yes
Enumeration Date:2005-12-19
Last Update Date:2019-07-12
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NJMA046151174400000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes174400000XOther Service ProvidersSpecialist
Provider Identifiers
StateIdentifier IDID TypeIssuer
NJGP190OtherOXFORD
NJ1067790Medicaid
NJ107468Medicaid
NJ14596Medicaid
NJ0104791001OtherAMERIHEALTH
NJ0K1374OtherHEALTHNET
NJ1742507Medicaid
NJ23578OtherAETNA