Basic Information
| Provider Information | |||||||||
| NPI: | 1952435760 | ||||||||
| EntityType: | 1 | ||||||||
| ReplacementNPI: | |||||||||
| OrganizationName: | |||||||||
| LastName: | CHUPAK | ||||||||
| FirstName: | CAROL ANNE | ||||||||
| MiddleName: | |||||||||
| NamePrefix: | MS. | ||||||||
| NameSuffix: | |||||||||
| Credential: | NP-C | ||||||||
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| Mailing Information | |||||||||
| Address1: | 277 FOREST AVE | ||||||||
| Address2: | |||||||||
| City: | PARAMUS | ||||||||
| State: | NJ | ||||||||
| PostalCode: | 076525428 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 2019861881 | ||||||||
| FaxNumber: | 2019861871 | ||||||||
| Practice Location | |||||||||
| Address1: | 277 FOREST AVE | ||||||||
| Address2: | |||||||||
| City: | PARAMUS | ||||||||
| State: | NJ | ||||||||
| PostalCode: | 076525428 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 2019861881 | ||||||||
| FaxNumber: | 2019861871 | ||||||||
| Other Information | |||||||||
| ProviderEnumerationDate: | 03/15/2007 | ||||||||
| LastUpdateDate: | 05/24/2010 | ||||||||
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| ProviderGenderCode: | F | ||||||||
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| IsSoleProprietor: | N | ||||||||
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Taxonomy Information
| Taxonomy | License | State | Switch | TaxonomyGroup | TaxonomyType | TaxonomyClass | SubSpecialty | 363LA2200X | 26NJ00055000 | NJ | Y | Physician Assistants & Advanced Practice Nursing Providers | Nurse Practitioner | Adult Health |
ID Information
| ID | Type | State | Issuer | Description | 26NJ00055000 | 01 | NJ | LICENSE | OTHER |