Healthcare Provider Details

I. General information

NPI: 1871749044
Provider Name (Legal Business Name): GREGORY KUPERMAN L.AC.
Entity Type: Individual
Gender: Male
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 08/07/2008
Last Update Date: 08/07/2008
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

180 BROADWAY SUITE 401
NEW YORK NY
10038
US

IV. Provider business mailing address

50 WEST 93 ST 6N
NEW YORK NY
10025
US

V. Phone/Fax

Practice location:
  • Phone: 212-964-5555
  • Fax: 212-932-3340
Mailing address:
  • Phone: 212-932-3340
  • Fax: 212-932-3340

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code171100000X
TaxonomyAcupuncturist
License Number
License Number State

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: