Healthcare Provider Details

I. General information

NPI: 1205937919
Provider Name (Legal Business Name): LEE MATTHEW KUPERSMITH M.D
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 09/26/2006
Last Update Date: 11/13/2013
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

205 FROEHLICH FARM BLVD
WOODBURY NY
11797-2931
US

IV. Provider business mailing address

205 FROEHLICH FARM BLVD
WOODBURY NY
11797-2931
US

V. Phone/Fax

Practice location:
  • Phone: 516-364-0070
  • Fax: 516-364-0242
Mailing address:
  • Phone: 516-364-0070
  • Fax: 516-364-0242

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code207X00000X
TaxonomyOrthopaedic Surgery Physician
License Number2118221
License Number StateNY

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: