Healthcare Provider Details

I. General information

NPI: 1912075342
Provider Name (Legal Business Name): LAUREN KUPERSMITH M.D.
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 12/02/2006
Last Update Date: 02/01/2021
Certification Date: 02/01/2021
Deactivation Date:
Reactivation Date:

III. Provider practice location address

180 E PULASKI RD
HUNTINGTON STATION NY
11746-1915
US

IV. Provider business mailing address

180 E PULASKI RD
HUNTINGTON STATION NY
11746-1915
US

V. Phone/Fax

Practice location:
  • Phone: 631-425-2110
  • Fax:
Mailing address:
  • Phone: 631-425-2121
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code208000000X
TaxonomyPediatrics Physician
License Number247146
License Number StateNY

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: