Healthcare Provider Details

I. General information

NPI: 1528162278
Provider Name (Legal Business Name): AVIVA KUPERSHTOK-BOJKO M.D.
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 09/12/2006
Last Update Date: 08/12/2008
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

200 S ORANGE AVE STE 101
LIVINGSTON NJ
07039-5817
US

IV. Provider business mailing address

18 E 41ST ST STE 1206
NEW YORK NY
10017-6222
US

V. Phone/Fax

Practice location:
  • Phone: 973-322-7580
  • Fax: 973-322-7505
Mailing address:
  • Phone: 212-725-8511
  • Fax: 212-726-7417

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code2084N0400X
TaxonomyNeurology Physician
License NumberMA72581
License Number StateNJ

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: