Healthcare Provider Details

I. General information

NPI: 1063633378
Provider Name (Legal Business Name): KATHLEEN BRADLEY KUPFERMAN N.P.
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 05/02/2007
Last Update Date: 07/08/2007
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

68 HAUPPAUGE RD
COMMACK NY
11725-4403
US

IV. Provider business mailing address

20 DELAWARE ST
HUNTINGTON NY
11743-3641
US

V. Phone/Fax

Practice location:
  • Phone: 631-715-2503
  • Fax:
Mailing address:
  • Phone: 631-385-1291
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code363LA2200X
TaxonomyAdult Health Nurse Practitioner
License NumberF302365-1
License Number StateNY

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: