Provider Demographics
NPI:1639773211
Name:ILYA KUPERSHTEIN MD PC
Entity Type:Organization
Organization Name:ILYA KUPERSHTEIN MD PC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:DR
Authorized Official - First Name:ILYA
Authorized Official - Middle Name:
Authorized Official - Last Name:KUPERSHTEIN
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:908-376-1525
Mailing Address - Street 1:33 OVERLOOK RD STE 305
Mailing Address - Street 2:
Mailing Address - City:SUMMIT
Mailing Address - State:NJ
Mailing Address - Zip Code:07901-3563
Mailing Address - Country:US
Mailing Address - Phone:908-376-1525
Mailing Address - Fax:908-396-1320
Practice Address - Street 1:33 OVERLOOK RD STE 305
Practice Address - Street 2:
Practice Address - City:SUMMIT
Practice Address - State:NJ
Practice Address - Zip Code:07901-3563
Practice Address - Country:US
Practice Address - Phone:908-376-1525
Practice Address - Fax:908-396-1320
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2020-11-24
Last Update Date:2020-11-24
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes207XS0117XAllopathic & Osteopathic PhysiciansOrthopaedic SurgeryOrthopaedic Surgery of the SpineGroup - Single Specialty