Provider Demographics
NPI:1891289914
Name:KUPRYK, LAURIE (PA-C)
Entity Type:Individual
Prefix:
First Name:LAURIE
Middle Name:
Last Name:KUPRYK
Suffix:
Gender:F
Credentials:PA-C
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1777 HAMBURG TPKE STE 304
Mailing Address - Street 2:
Mailing Address - City:WAYNE
Mailing Address - State:NJ
Mailing Address - Zip Code:07470-5243
Mailing Address - Country:US
Mailing Address - Phone:973-444-4558
Mailing Address - Fax:973-444-7466
Practice Address - Street 1:1777 HAMBURG TPKE STE 304
Practice Address - Street 2:
Practice Address - City:WAYNE
Practice Address - State:NJ
Practice Address - Zip Code:07470-5243
Practice Address - Country:US
Practice Address - Phone:973-444-4558
Practice Address - Fax:973-444-7466
Is Sole Proprietor?:Yes
Enumeration Date:2018-06-21
Last Update Date:2024-03-05
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NJMK6383513363AM0700X, 363A00000X
NY022081363AS0400X, 363A00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363A00000XPhysician Assistants & Advanced Practice Nursing ProvidersPhysician Assistant
No363AM0700XPhysician Assistants & Advanced Practice Nursing ProvidersPhysician AssistantMedical
No363AS0400XPhysician Assistants & Advanced Practice Nursing ProvidersPhysician AssistantSurgical