Healthcare Provider Details

I. General information

NPI: 1972133791
Provider Name (Legal Business Name): MARINA KUPERMAN FAMILY HEALTH NP PC.
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 01/21/2020
Last Update Date: 10/30/2020
Certification Date: 10/30/2020
Deactivation Date:
Reactivation Date:

III. Provider practice location address

326 7TH ST
BROOKLYN NY
11215-3311
US

IV. Provider business mailing address

4768 HYLAN BLVD
STATEN ISLAND NY
10312-6314
US

V. Phone/Fax

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

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code363LX0001X
TaxonomyObstetrics & Gynecology Nurse Practitioner
License Number
License Number State

VIII. Authorized Official

Name: MARINA KUPERMAN
Title or Position: OWNER
Credential: FNP
Phone: 718-355-9705