Healthcare Provider Details

I. General information

NPI: 1215166285
Provider Name (Legal Business Name): SHILAMIDA KUPERSHTEYN L.AC, MT
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 07/10/2009
Last Update Date: 03/27/2013
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

13-45 SPERBER RD
FAIR LAWN NJ
07410-7362
US

IV. Provider business mailing address

13-45 SPERBER RD APT D
FAIR LAWN NJ
07410-7362
US

V. Phone/Fax

Practice location:
  • Phone: 201-410-1756
  • Fax:
Mailing address:
  • Phone: 201-410-1756
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code225700000X
TaxonomyMassage Therapist
License Number
License Number State
# 2
Primary TaxonomyY
Taxonomy Code171100000X
TaxonomyAcupuncturist
License Number004962-1
License Number StateNY

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: