Keith Adam Krupa, LPN

Primary specialty

Adult Psychiatric/Mental Health Registered NurseTaxonomy code 163WP0809X

License

893109 Issued in NY

Practice address

19 Laurita Gate
Port Jefferson, NY 11777-2113

Phone

(631) 413-1717

NPI assigned

Sep 8, 2020

Sex

Male

Sole proprietor

Yes

Registry information is reported by the provider to CMS and is not verified. About this source

Specialties & licenses 1

Addresses

Electronic endpoints 1

Medicare fee-for-service enrollment

Not listed in the public Medicare enrollment file

Medicare enrollment (NPD)

Not enrolled

State licenses

The complete NPPES record for this NPI in the NPI Registry API format.

{
    "created_epoch": "1599523200000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1688601600000",
    "number": "1376157388",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "200 WIRELESS BLVD",
            "city": "HAUPPAUGE",
            "state": "NY",
            "postal_code": "117883974"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "19 LAURITA GATE",
            "city": "PORT JEFFERSON",
            "state": "NY",
            "postal_code": "117772113",
            "telephone_number": "631-413-1717"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "KRUPA",
        "first_name": "KEITH",
        "middle_name": "ADAM",
        "credential": "LPN",
        "sole_proprietor": "YES",
        "sex": "M",
        "enumeration_date": "2020-09-08",
        "last_updated": "2023-07-06",
        "certification_date": "2023-07-06",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "163WP0809X",
            "taxonomy_group": "",
            "desc": "Registered Nurse, Psychiatric/Mental Health, Adult",
            "state": "NY",
            "license": "893109",
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [
        {
            "endpointType": "OTHERS",
            "endpointTypeDescription": "Other URL",
            "endpoint": "Keith.krupa@lisvh.org",
            "affiliation": "N",
            "address_1": "19 Laurita Gate",
            "city": "Port Jefferson",
            "state": "NY",
            "country_code": "US",
            "postal_code": "117772113",
            "country_name": "United States",
            "address_type": "DOM"
        }
    ],
    "other_names": []
}

• Kristen Krawczyk, D.P.T
• Michelle Lynn Krebo
• Jacqueline Kroon, RD
• Mark J. Kropf, M.D.
• Alain Kruh
• Lynne A Kulakowski, LMSW
• Georgia Kulina, M.D.
• Kevin Andrew Kunz
• Anthony Brian Kwan, MD
• Cara Elizabeth La Gala

• Adult Psychiatric/Mental Health Registered Nurse in Port Jefferson, NY
• Providers in Port Jefferson, NY by specialty
• Adult Psychiatric/Mental Health Registered Nurse in New York

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Jul 6, 2023; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
• National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.

Verify at the official NPI Registry.