Basic Information
Provider Information
NPI: 1477070167
EntityType: 1
ReplacementNPI:  
OrganizationName:  
LastName: STUPI
FirstName: KYLE
MiddleName:  
NamePrefix: DR.
NameSuffix:  
Credential: PT, DPT, CSCS
OtherOrganizationName:  
OtherOrganizationType:  
OtherLastName:  
OtherFirstName:  
OtherMiddleName:  
OtherNamePrefix:  
OtherNameSuffix:  
OtherCredential:  
OtherLastNameType:  
Mailing Information
Address1: 307 5TH AVE FL 6
Address2:  
City: NEW YORK
State: NY
PostalCode: 100166575
CountryCode: US
TelephoneNumber: 2127592282
FaxNumber: 2123792123
Practice Location
Address1: 269 W 16TH ST
Address2:  
City: NEW YORK
State: NY
PostalCode: 100116000
CountryCode: US
TelephoneNumber: 6468411411
FaxNumber: 2123792121
Other Information
ProviderEnumerationDate: 08/24/2017
LastUpdateDate: 06/14/2019
NPIDeactivationReasonCode:  
NPIDeactivationDate:  
NPIReactivationDate:  
ProviderGenderCode: M
AuthorizedOfficialLastName:  
AuthorizedOfficialFirstName:  
AuthorizedOfficialMiddleName:  
AuthorizedOfficialTitleorPosition:  
AuthorizedOfficialTelephone:  
IsSoleProprietor: N
IsOrganizationSubpart:  
ParentOrganizationLBN:  
AuthorizedOfficialNamePrefix:  
AuthorizedOfficialNameSuffix:  
AuthorizedOfficialCredential:  
NPICertificationDate:  

Taxonomy Information
TaxonomyLicenseStateSwitchTaxonomyGroupTaxonomyTypeTaxonomyClassSubSpecialty
225100000X041954NYY Respiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical Therapist 

No ID Information.


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