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General NPI Number Information
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NPI Number | 1639773211
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Entity Type | Organization
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Legal Business Name | ILYA KUPERSHTEIN MD PC
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Dates
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Enumeration Date | 11/24/2020
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Last Update Date | 11/24/2020
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Provider Practice Location Address
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Address Line | 33 OVERLOOK RD STE 305
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City | SUMMIT
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State | NJ
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Zip | 07901-3563
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Country | US
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Telephone | 908-376-1525
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Fax | 908-396-1320
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Provider Business Mailing Address
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Address Line | 33 OVERLOOK RD STE 305
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City | SUMMIT
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State | NJ
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Zip | 07901-3563
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Country | US
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Telephone | 908-376-1525
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Fax | 908-396-1320
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Authorized Official
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Title or Position | OWNER
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Name | DR. ILYA KUPERSHTEIN
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Credential | MD
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Telephone | 908-376-1525
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 207XS0117X
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Taxonomy Name | Orthopaedic Surgery of the Spine Physician
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License Number |
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License Number State |
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