Provider Demographics
NPI:1972536241
Name:KUPERSMIT, MARVIN A (DO)
Entity Type:Individual
Prefix:DR
First Name:MARVIN
Middle Name:A
Last Name:KUPERSMIT
Suffix:
Gender:M
Credentials:DO
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:333 REGATTA DR
Mailing Address - Street 2:
Mailing Address - City:JUPITER
Mailing Address - State:FL
Mailing Address - Zip Code:33477-4077
Mailing Address - Country:US
Mailing Address - Phone:561-575-3296
Mailing Address - Fax:
Practice Address - Street 1:333 REGATTA DR
Practice Address - Street 2:
Practice Address - City:JUPITER
Practice Address - State:FL
Practice Address - Zip Code:33477-4077
Practice Address - Country:US
Practice Address - Phone:561-575-3296
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2006-07-09
Last Update Date:2008-06-26
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NJ25MB023623002085R0202X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes2085R0202XAllopathic & Osteopathic PhysiciansRadiologyDiagnostic Radiology