Healthcare Provider Details

I. General information

NPI: 1750406880
Provider Name (Legal Business Name): ELAINE KUPERSTEIN CDE RD MS
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 03/20/2007
Last Update Date: 07/08/2007
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

8 NEWKIRK AVE
EAST ROCKAWAY NY
11518-1312
US

IV. Provider business mailing address

8 NEWKIRK AVE
EAST ROCKAWAY NY
11518-1312
US

V. Phone/Fax

Practice location:
  • Phone: 516-599-2376
  • Fax:
Mailing address:
  • Phone: 516-599-2376
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code133VN1006X
TaxonomyMetabolic Nutrition Registered Dietitian
License Number000981
License Number StateNY

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: