Healthcare Provider Details

I. General information

NPI: 1497590145
Provider Name (Legal Business Name): RAPHAEL KUPFERMAN PT, DPT
Entity Type: Individual
Gender: Male
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 06/26/2024
Last Update Date: 06/26/2024
Certification Date: 06/25/2024
Deactivation Date:
Reactivation Date:

III. Provider practice location address

558 E CRESCENT AVE STE 203
UPPER SADDLE RIVER NJ
07458-1827
US

IV. Provider business mailing address

1311 MAMARONECK AVE STE 140
WHITE PLAINS NY
10605-5224
US

V. Phone/Fax

Practice location:
  • Phone: 201-633-2100
  • Fax:
Mailing address:
  • Phone: 914-294-4050
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code225100000X
TaxonomyPhysical Therapist
License Number40QA01458000
License Number StateNJ

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: