Provider Demographics
NPI:1972133791
Name:MARINA KUPERMAN FAMILY HEALTH NP PC.
Entity Type:Organization
Organization Name:MARINA KUPERMAN FAMILY HEALTH NP PC.
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:
Authorized Official - First Name:MARINA
Authorized Official - Middle Name:
Authorized Official - Last Name:KUPERMAN
Authorized Official - Suffix:
Authorized Official - Credentials:FNP
Authorized Official - Phone:718-355-9705
Mailing Address - Street 1:4768 HYLAN BLVD
Mailing Address - Street 2:
Mailing Address - City:STATEN ISLAND
Mailing Address - State:NY
Mailing Address - Zip Code:10312-6314
Mailing Address - Country:US
Mailing Address - Phone:718-355-9705
Mailing Address - Fax:
Practice Address - Street 1:326 7TH ST
Practice Address - Street 2:
Practice Address - City:BROOKLYN
Practice Address - State:NY
Practice Address - Zip Code:11215-3311
Practice Address - Country:US
Practice Address - Phone:718-753-3207
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2020-01-21
Last Update Date:2020-10-30
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes363LX0001XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerObstetrics & GynecologyGroup - Single Specialty