Active NPI
Samuel Lupin, MD
- Specialist
- Brooklyn, NY
National Provider Identifier
1366646572
On this page
Key facts
NPPES NPI Registry- Primary specialty
- Specialist
- License
- 138014
- Practice address
- 3131 Kings Hwy
Suite B1
Brooklyn, NY 11234-2644 - Phone
- (845) 356-9433
- Fax
- (845) 371-5897
- NPI assigned
- Jun 12, 2007
- Sex
- Male
- Sole proprietor
- Yes
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 |
|---|---|---|---|---|
| Specialist | 174400000X | 138014 | NY | Primary |
Addresses
Primary practice location
3131 Kings Hwy
Suite B1
Brooklyn, NY 11234-2644
Mailing address
6 Lynhaven CT
Monsey, NY 10952-2411
Phone (845) 356-9433
Other identifiers 5
| Identifier | Type | State | Issuer |
|---|---|---|---|
| P770149 | Other | NY | OXFORD |
| 0035751 | Other | NY | GHI |
| 31A671 | Other | NY | BLUE CROSS BLUE SHIELD |
| 00799555 | Medicaid | NY | |
| NZ8794 | Other | NY | HEALTHNET |
Medicare participation
Medicare enrollment files- Medicare fee-for-service enrollment
- Not listed in the public Medicare enrollment file
- Eligible to order & refer
- Part B services: No
- Medical equipment: Yes
- Home health: No
- Power mobility devices: Yes
- Hospice: No
National Provider Directory
National Provider Directory- Medicare enrollment (NPD)
- Enrolled
- Credentials
- Doctor of Medicine
State licenses
| License | State | Type | Specialty |
|---|---|---|---|
| 138014 | NY | MD | Specialist |
NPI Registry JSON
The complete NPPES record for this NPI in the NPI Registry API format.
{
"created_epoch": "1181606400000",
"enumeration_type": "NPI-1",
"last_updated_epoch": "1274745600000",
"number": "1366646572",
"addresses": [
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "MAILING",
"address_type": "DOM",
"address_1": "6 LYNHAVEN CT",
"city": "MONSEY",
"state": "NY",
"postal_code": "109522411",
"telephone_number": "845-356-9433",
"fax_number": "845-371-5897"
},
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "LOCATION",
"address_type": "DOM",
"address_1": "3131 KINGS HWY",
"address_2": "SUITE B1",
"city": "BROOKLYN",
"state": "NY",
"postal_code": "112342644",
"telephone_number": "845-356-9433",
"fax_number": "845-371-5897"
}
],
"practiceLocations": [],
"basic": {
"last_name": "LUPIN",
"first_name": "SAMUEL",
"credential": "MD",
"sole_proprietor": "YES",
"sex": "M",
"enumeration_date": "2007-06-12",
"last_updated": "2010-05-25",
"status": "A"
},
"taxonomies": [
{
"code": "174400000X",
"taxonomy_group": "",
"desc": "Specialist",
"state": "NY",
"license": "138014",
"primary": true
}
],
"identifiers": [
{
"code": "01",
"desc": "Other (non-Medicare)",
"issuer": "OXFORD",
"identifier": "P770149",
"state": "NY"
},
{
"code": "01",
"desc": "Other (non-Medicare)",
"issuer": "GHI",
"identifier": "0035751",
"state": "NY"
},
{
"code": "01",
"desc": "Other (non-Medicare)",
"issuer": "BLUE CROSS BLUE SHIELD",
"identifier": "31A671",
"state": "NY"
},
{
"code": "05",
"desc": "MEDICAID",
"issuer": null,
"identifier": "00799555",
"state": "NY"
},
{
"code": "01",
"desc": "Other (non-Medicare)",
"issuer": "HEALTHNET",
"identifier": "NZ8794",
"state": "NY"
}
],
"endpoints": [],
"other_names": []
}Other providers in Brooklyn, NY
Sources for this page
- NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on May 25, 2010; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
- Medicare enrollment (CMS PECOS): enrollments, PAC IDs and benefit reassignments; Order and Referring.
- National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.