Provider Demographics
NPI:1053560128
Name:MAREK R. LUPICKI MD PC
Entity type:Organization
Organization Name:MAREK R. LUPICKI MD PC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PRESIDENT
Authorized Official - Prefix:DR
Authorized Official - First Name:MAREK
Authorized Official - Middle Name:ROBERT
Authorized Official - Last Name:LUPICKI
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:732-553-1000
Mailing Address - Street 1:200 PERRINE RD
Mailing Address - Street 2:SUITE 211
Mailing Address - City:OLD BRIDGE
Mailing Address - State:NJ
Mailing Address - Zip Code:08857-2842
Mailing Address - Country:US
Mailing Address - Phone:732-553-1000
Mailing Address - Fax:732-553-1003
Practice Address - Street 1:200 PERRINE ROAD
Practice Address - Street 2:SUITE 211
Practice Address - City:OLD BRIDGE
Practice Address - State:NJ
Practice Address - Zip Code:08857-2836
Practice Address - Country:US
Practice Address - Phone:732-553-1000
Practice Address - Fax:732-553-1003
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2008-09-15
Last Update Date:2008-12-12
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes208D00000XAllopathic & Osteopathic PhysiciansGeneral PracticeGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
NJ086961Medicare PIN