Provider Demographics
NPI:1982057261
Name:ZUPO, JENNY
Entity type:Individual
Prefix:
First Name:JENNY
Middle Name:
Last Name:ZUPO
Suffix:
Gender:
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:17 SEAVER LN
Mailing Address - Street 2:
Mailing Address - City:SMITHTOWN
Mailing Address - State:NY
Mailing Address - Zip Code:11787-4924
Mailing Address - Country:US
Mailing Address - Phone:631-882-7386
Mailing Address - Fax:
Practice Address - Street 1:4 FERN PL
Practice Address - Street 2:
Practice Address - City:PLAINVIEW
Practice Address - State:NY
Practice Address - Zip Code:11803-4725
Practice Address - Country:US
Practice Address - Phone:516-933-4700
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2016-07-21
Last Update Date:2025-04-10
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY2648673174H00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes174H00000XOther Service ProvidersHealth Educator