Provider Demographics
NPI:1922089655
Name:KUPERSMITH, MARK J (MD)
Entity Type:Individual
Prefix:
First Name:MARK
Middle Name:J
Last Name:KUPERSMITH
Suffix:
Gender:M
Credentials:MD
Other - Prefix:
Other - First Name:
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Other - Credentials:
Mailing Address - Street 1:1000 10TH AVE
Mailing Address - Street 2:10TH FLOOR RM INN
Mailing Address - City:NEW YORK
Mailing Address - State:NY
Mailing Address - Zip Code:10019-1147
Mailing Address - Country:US
Mailing Address - Phone:212-636-3200
Mailing Address - Fax:212-636-3195
Practice Address - Street 1:1000 10TH AVE
Practice Address - Street 2:10TH FL RM INN
Practice Address - City:NEW YORK
Practice Address - State:NY
Practice Address - Zip Code:10019-1147
Practice Address - Country:US
Practice Address - Phone:212-636-3200
Practice Address - Fax:212-636-3195
Is Sole Proprietor?:Yes
Enumeration Date:2005-11-09
Last Update Date:2014-01-15
Deactivation Date:
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Provider Licenses
StateLicense IDTaxonomies
NY129274 1207W00000X
NY125274207T00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207W00000XAllopathic & Osteopathic PhysiciansOphthalmology
No207T00000XAllopathic & Osteopathic PhysiciansNeurological Surgery
Provider Identifiers
StateIdentifier IDID TypeIssuer
NY01413625Medicaid
NY01413625Medicaid
NY26A412Medicare ID - Type Unspecified