Provider Demographics
NPI:1760008494
Name:KOUPERBERG, EFIM
Entity Type:Individual
Prefix:
First Name:EFIM
Middle Name:
Last Name:KOUPERBERG
Suffix:
Gender:M
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:2075 GREENBRIAR RD
Mailing Address - Street 2:
Mailing Address - City:YORK
Mailing Address - State:PA
Mailing Address - Zip Code:17404-9132
Mailing Address - Country:US
Mailing Address - Phone:410-428-4155
Mailing Address - Fax:171-744-1383
Practice Address - Street 1:2075 GREENBRIAR RD
Practice Address - Street 2:
Practice Address - City:YORK
Practice Address - State:PA
Practice Address - Zip Code:17404-9132
Practice Address - Country:US
Practice Address - Phone:410-428-4155
Practice Address - Fax:171-744-1383
Is Sole Proprietor?:Yes
Enumeration Date:2020-06-18
Last Update Date:2020-06-18
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MD106370246XC2903X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes246XC2903XTechnologists, Technicians & Other Technical Service ProvidersSpecialist/Technologist CardiovascularVascular SpecialistGroup - Single Specialty