Provider Demographics
NPI:1033504766
Name:KUPFERSTEIN, MOSHE (DO)
Entity Type:Individual
Prefix:
First Name:MOSHE
Middle Name:
Last Name:KUPFERSTEIN
Suffix:
Gender:M
Credentials:DO
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:173 MARTIN AVE
Mailing Address - Street 2:
Mailing Address - City:STATEN ISLAND
Mailing Address - State:NY
Mailing Address - Zip Code:10314-4325
Mailing Address - Country:US
Mailing Address - Phone:305-748-9785
Mailing Address - Fax:
Practice Address - Street 1:150 NEW PROVIDENCE RD
Practice Address - Street 2:
Practice Address - City:MOUNTAINSIDE
Practice Address - State:NJ
Practice Address - Zip Code:07092-2590
Practice Address - Country:US
Practice Address - Phone:888-244-5373
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2015-03-31
Last Update Date:2023-11-17
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NJ25MB11061600208000000X
NY292383208000000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes208000000XAllopathic & Osteopathic PhysiciansPediatrics