Healthcare Provider Details

I. General information

NPI: 1629128327
Provider Name (Legal Business Name): ABRAHAM KUPERBERG PH.D.
Entity Type: Individual
Gender: Male
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 01/12/2007
Last Update Date: 07/08/2007
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

2-31 SUMMIT AVE
FAIR LAWN NJ
07410-2043
US

IV. Provider business mailing address

2-31 SUMMIT AVE
FAIR LAWN NJ
07410-2043
US

V. Phone/Fax

Practice location:
  • Phone: 201-796-2014
  • Fax: 888-453-1609
Mailing address:
  • Phone: 201-796-2014
  • Fax: 888-453-1609

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code103T00000X
TaxonomyPsychologist
License Number2050
License Number StateNJ

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: