1548445745 NPI number — MRS. TATIANA N DUPERE RPT REGISTERED PHYSI

Table of content: MRS. TATIANA N DUPERE RPT REGISTERED PHYSI (NPI 1548445745)

General

This information contains only most important part of the NPI data, for complete information, including NPI referencing materials please refer to 1548445745 NPI number — MRS. TATIANA N DUPERE RPT REGISTERED PHYSI

Organization/Personal Information

Employer Identification Number (EIN):
Provider Organization Name:
Provider Last Name:
DUPERE
Provider First Name:
TATIANA
Provider Middle Name:
N
Provider Name Prefix Text:
MRS.
Provider Name Suffix Text:
Provider Credential Text:
RPT REGISTERED PHYSI
Provider Gender Code:
F

Provider's Other Name Information

Provider Other Organization Name:
Provider Other Organization Name Type Code:
Provider Other Last Name:
Provider Other First Name:
Provider Other Middle Name:
Provider Other Name Prefix Text:
Provider Other Name Suffix Text:
Provider Other Credential Text:
Provider Other Last Name Type Code:

NPI Number Information

NPI Number:
1548445745
Entity Type Code:
Individual
Replacement NPI:
Last Update Date:
01/07/2008
NPI Deactivation Reason Code:
NPI Deactivation Date:
NPI Reactivation Date:

Provider's Business Mailing Address

Provider First Line Business Mailing Address:
470 PINEWOOD DRIVE
Provider Second Line Business Mailing Address:
Provider Business Mailing Address City Name:
LONGMEADOW
Provider Business Mailing Address State Name:
MA
Provider Business Mailing Address Postal Code:
01106-1644
Provider Business Mailing Address Country Code:
US
Provider Business Mailing Address Telephone Number:
413-567-2170
Provider Business Mailing Address Fax Number:

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
93 WATERBURY ROAD
Provider Second Line Business Practice Location Address:
RIFKIN PHYSICAL THERAPY AND LYMPHEDEMA CENTER LLC
Provider Business Practice Location Address City Name:
PROSPECT
Provider Business Practice Location Address State Name:
CT
Provider Business Practice Location Address Postal Code:
06712-1482
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
203-758-6569
Provider Business Practice Location Address Fax Number:
203-758-0443
Provider Enumeration Date:
01/07/2008

Additional Information

Authorized Official

Authorized Official Last Name:
Authorized Official First Name:
Authorized Official Middle Name:
Authorized Official Title or Position:
Authorized Official Telephone Number:

Provider Taxonomy Codes

  • Taxonomy code: 225100000X , with the licence number:  006528 , registered in the state of CT ; information, associated with the NPI states the following Primary Taxonomy Switch: "Y" .
  • Taxonomy code: 225100000X , with the licence number: 15050 , registered in the state of MA ; information, associated with the NPI states the following Primary Taxonomy Switch: "N" .

Other Provider's Identifiers (legacy, non-NPI)





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