Provider Demographics
NPI:1093984858
Name:LAURA KUPERMAN, MD. PC
Entity Type:Organization
Organization Name:LAURA KUPERMAN, MD. PC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:DR
Authorized Official - First Name:LAURA
Authorized Official - Middle Name:
Authorized Official - Last Name:KUPERMAN
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:718-261-1112
Mailing Address - Street 1:55 FERNWOOD LN
Mailing Address - Street 2:
Mailing Address - City:ROSLYN
Mailing Address - State:NY
Mailing Address - Zip Code:11576-1429
Mailing Address - Country:US
Mailing Address - Phone:718-261-1112
Mailing Address - Fax:718-261-6040
Practice Address - Street 1:10848 70TH RD
Practice Address - Street 2:SUITE 2E
Practice Address - City:FOREST HILLS
Practice Address - State:NY
Practice Address - Zip Code:11375-3961
Practice Address - Country:US
Practice Address - Phone:718-261-1112
Practice Address - Fax:718-261-6040
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2008-02-26
Last Update Date:2008-08-14
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY206549207V00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes207V00000XAllopathic & Osteopathic PhysiciansObstetrics & GynecologyGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
NY01921851Medicaid
NYG91312Medicare UPIN
NY01921851Medicaid