Active NPI
Jennie Lupo, DDS
- Dentist
- Bayside, NY
National Provider Identifier
1306032453
On this page
Key facts
NPPES NPI Registry- Primary specialty
- Dentist
- License
- 052897-1
- Practice address
- 4021 Bell Blvd
2ND Floor
Bayside, NY 11361-2041 - Phone
- (718) 352-5582
- NPI assigned
- Sep 22, 2007
- Sex
- Female
- Sole proprietor
- No
NPPES NPI Registry
Registry information is reported by the provider to CMS and is not verified. About this source
Specialties & licenses 1
| Specialty (taxonomy) | Code | License | State | Primary |
|---|---|---|---|---|
| Dentist | 122300000X | 052897-1 | NY | Primary |
Addresses
Primary practice location
4021 Bell Blvd
2ND Floor
Bayside, NY 11361-2041
Mailing address
4021 Bell Blvd
2ND Floor
Bayside, NY 11361-2041
Phone (718) 352-5582
Medicare participation
Medicare enrollment files- Medicare fee-for-service enrollment
- Not listed in the public Medicare enrollment file
National Provider Directory
National Provider Directory- Medicare enrollment (NPD)
- Not enrolled
State licenses
| License | State | Type | Specialty |
|---|---|---|---|
| 052897-1 | NY | MD | Dentist |
NPI Registry JSON
The complete NPPES record for this NPI in the NPI Registry API format.
{
"created_epoch": "1190419200000",
"enumeration_type": "NPI-1",
"last_updated_epoch": "1225238400000",
"number": "1306032453",
"addresses": [
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "MAILING",
"address_type": "DOM",
"address_1": "4021 BELL BLVD",
"address_2": "2ND FLOOR",
"city": "BAYSIDE",
"state": "NY",
"postal_code": "113612041",
"telephone_number": "718-352-5582"
},
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "LOCATION",
"address_type": "DOM",
"address_1": "4021 BELL BLVD",
"address_2": "2ND FLOOR",
"city": "BAYSIDE",
"state": "NY",
"postal_code": "113612041",
"telephone_number": "718-352-5582"
}
],
"practiceLocations": [],
"basic": {
"last_name": "LUPO",
"first_name": "JENNIE",
"name_prefix": "Dr.",
"credential": "DDS",
"sole_proprietor": "NO",
"sex": "F",
"enumeration_date": "2007-09-22",
"last_updated": "2008-10-29",
"status": "A"
},
"taxonomies": [
{
"code": "122300000X",
"taxonomy_group": "",
"desc": "Dentist",
"state": "NY",
"license": "052897-1",
"primary": true
}
],
"identifiers": [],
"endpoints": [],
"other_names": []
}Other providers in Bayside, NY
Sources for this page
- NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Oct 29, 2008; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
- National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.