Healthcare Provider Details

I. General information

NPI: 1821636259
Provider Name (Legal Business Name): YISROEL KUPFERSTEIN
Entity Type: Individual
Gender: Male
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 12/17/2019
Last Update Date: 12/17/2019
Certification Date: 12/17/2019
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1047 E 29TH ST
BROOKLYN NY
11210-3743
US

IV. Provider business mailing address

1047 E 29TH ST
BROOKLYN NY
11210-3743
US

V. Phone/Fax

Practice location:
  • Phone: 917-674-0723
  • Fax:
Mailing address:
  • Phone:
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code363A00000X
TaxonomyPhysician Assistant
License Number024530-01
License Number StateNY

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: