Healthcare Provider Details

I. General information

NPI: 1467465617
Provider Name (Legal Business Name): LAURA KUPERMAN MD
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 08/15/2006
Last Update Date: 07/08/2007
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

10848 70TH RD 2E
FOREST HILLS NY
11375-3961
US

IV. Provider business mailing address

55 FERNWOOD LN
ROSLYN NY
11576-1429
US

V. Phone/Fax

Practice location:
  • Phone: 718-261-1112
  • Fax: 718-261-6040
Mailing address:
  • Phone: 516-627-9310
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code207V00000X
TaxonomyObstetrics & Gynecology Physician
License Number206549
License Number StateNY

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: