| Doctor Name: | GINA RUPERT |
| NPI Number: | 1184652711 |
| Entity Type Code: | Individual (1) |
| Gender: | F |
| Credentials: | PAC |
| License Number: | 001710 |
| Business Practice Address: | 385 Main St South Ste 301 Union Square Southbury, CT - 06488 |
| Business Phone Number: | 2032643319 |
| Business Fax Number: | 2032676382 |
| Mailing Address: | 385 Main St South, Ste 301 Union Square SOUTHBURY |
| State: | CT |
| Postal Code: | 06488 |
| Phone Number: | 2032643319 |
| Fax Number: | 2032676382 |
| NPI Enumeration Date: | 06/30/2006 |
| NPI Last Update Date: | 01/14/2014 |
| Replacement NPI: | 0 |
| NPI Deactivation Date: | |
| NPI Reactivation Date: |
Taxonomy Information: | |
| Healthcare Provider Taxonomy: | 363AM0700X |
| License Number: | 001710 |
| Healthcare Provider Taxonomy: (Secondary) | Y |
| State: | CT |
| Taxonomy Type: | Physician Assistants & Advanced Practice Nursing Providers |
| Taxonomy Classification: | Physician Assistant |
| Taxonomy Specialization: | Medical |
| Taxonomy Definition: | |