Healthcare Provider Details

I. General information

NPI: 1245447135
Provider Name (Legal Business Name): SANDRA KUPFERMAN DMD
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 05/17/2007
Last Update Date: 07/08/2007
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

36 W 44TH ST SUITE905
NEW YORK NY
10036-8102
US

IV. Provider business mailing address

630 1ST AVE APT 32A
NEW YORK NY
10016-3700
US

V. Phone/Fax

Practice location:
  • Phone: 212-768-4091
  • Fax:
Mailing address:
  • Phone: 212-684-2428
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code1223P0300X
TaxonomyPeriodontics
License Number047752
License Number StateNY

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: