Healthcare Provider Details

I. General information

NPI: 1366312589
Provider Name (Legal Business Name): MARCY KUPFERSTEIN
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 11/11/2025
Last Update Date: 11/11/2025
Certification Date: 11/11/2025
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1056 E 18TH ST
BROOKLYN NY
11230-4406
US

IV. Provider business mailing address

1056 E 18TH ST
BROOKLYN NY
11230-4406
US

V. Phone/Fax

Practice location:
  • Phone: 917-365-7412
  • Fax:
Mailing address:
  • Phone:
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code363A00000X
TaxonomyPhysician Assistant
License Number003331
License Number StateNY

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: