Provider Demographics
NPI:1225690886
Name:KUPFERBERG, TAYLOR (OD)
Entity Type:Individual
Prefix:
First Name:TAYLOR
Middle Name:
Last Name:KUPFERBERG
Suffix:
Gender:F
Credentials:OD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:171 RAMAPO RD STE 2
Mailing Address - Street 2:
Mailing Address - City:GARNERVILLE
Mailing Address - State:NY
Mailing Address - Zip Code:10923-1569
Mailing Address - Country:US
Mailing Address - Phone:845-947-2240
Mailing Address - Fax:
Practice Address - Street 1:171 RAMAPO RD STE 2
Practice Address - Street 2:
Practice Address - City:GARNERVILLE
Practice Address - State:NY
Practice Address - Zip Code:10923-1569
Practice Address - Country:US
Practice Address - Phone:845-947-2240
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2019-07-03
Last Update Date:2020-12-02
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NJ27OA00688300152W00000X
NY008990152W00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes152W00000XEye and Vision Services ProvidersOptometristGroup - Single Specialty