Healthcare Provider Details

I. General information

NPI: 1043642887
Provider Name (Legal Business Name): MARINA KUPERMAN FNP
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 08/03/2013
Last Update Date: 08/06/2024
Certification Date: 08/06/2024
Deactivation Date:
Reactivation Date:

III. Provider practice location address

350 91ST ST STE 1A
BROOKLYN NY
11209-5853
US

IV. Provider business mailing address

4768 HYLAN BLVD
STATEN ISLAND NY
10312-6314
US

V. Phone/Fax

Practice location:
  • Phone: 718-355-9705
  • Fax: 718-355-8466
Mailing address:
  • Phone: 718-753-3207
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code363LX0001X
TaxonomyObstetrics & Gynecology Nurse Practitioner
License NumberF3374991
License Number StateNY
# 2
Primary TaxonomyY
Taxonomy Code363LP2300X
TaxonomyPrimary Care Nurse Practitioner
License NumberF337499
License Number StateNY

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: