Provider Demographics
NPI:1174522726
Name:KRUPEN, JEFFREY (MD)
Entity type:Individual
Prefix:DR
First Name:JEFFREY
Middle Name:
Last Name:KRUPEN
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 1:21432 43RD AVE
Mailing Address - Street 2:
Mailing Address - City:BAYSIDE
Mailing Address - State:NY
Mailing Address - Zip Code:11361-2956
Mailing Address - Country:US
Mailing Address - Phone:718-224-7200
Mailing Address - Fax:718-224-7582
Practice Address - Street 1:21432 43RD AVE
Practice Address - Street 2:
Practice Address - City:BAYSIDE
Practice Address - State:NY
Practice Address - Zip Code:11361-2956
Practice Address - Country:US
Practice Address - Phone:718-224-7200
Practice Address - Fax:718-224-7582
Is Sole Proprietor?:Yes
Enumeration Date:2005-07-17
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY155153207R00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207R00000XAllopathic & Osteopathic PhysiciansInternal Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
NY77173Medicare ID - Type Unspecified
NY44D382Medicare ID - Type Unspecified
NYB88768Medicare UPIN