Provider Demographics
NPI:1174734966
Name:KUREPA, DALIBOR N
Entity type:Individual
Prefix:DR
First Name:DALIBOR
Middle Name:N
Last Name:KUREPA
Suffix:
Gender:M
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:60 WESTWOOD DR
Mailing Address - Street 2:APT 68
Mailing Address - City:WESTBURY
Mailing Address - State:NY
Mailing Address - Zip Code:11590-1613
Mailing Address - Country:US
Mailing Address - Phone:318-780-3804
Mailing Address - Fax:
Practice Address - Street 1:269-01 76TH AVENUE
Practice Address - Street 2:NEONATOLOGY DIVISION NSLIJ
Practice Address - City:NEW HYDE PARK
Practice Address - State:NY
Practice Address - Zip Code:11040
Practice Address - Country:US
Practice Address - Phone:718-470-3440
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2007-05-24
Last Update Date:2014-11-25
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY2759222080N0001X, 2080N0001X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes2080N0001XAllopathic & Osteopathic PhysiciansPediatricsNeonatal-Perinatal Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
LA1072206Medicaid
LA4P051F600Medicare PIN