Provider Demographics
NPI:1134379340
Name:KUPERSHTEIN, ILYA (MD)
Entity type:Individual
Prefix:DR
First Name:ILYA
Middle Name:
Last Name:KUPERSHTEIN
Suffix:
Gender:M
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:33 OVERLOOK RD STE 305
Mailing Address - Street 2:
Mailing Address - City:SUMMIT
Mailing Address - State:NJ
Mailing Address - Zip Code:07901-3563
Mailing Address - Country:US
Mailing Address - Phone:908-376-1525
Mailing Address - Fax:908-396-1320
Practice Address - Street 1:33 OVERLOOK RD STE 305
Practice Address - Street 2:
Practice Address - City:SUMMIT
Practice Address - State:NJ
Practice Address - Zip Code:07901-3563
Practice Address - Country:US
Practice Address - Phone:908-376-1525
Practice Address - Fax:908-396-1320
Is Sole Proprietor?:Yes
Enumeration Date:2008-09-24
Last Update Date:2020-11-24
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NJ25MA08778400207XS0117X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207XS0117XAllopathic & Osteopathic PhysiciansOrthopaedic SurgeryOrthopaedic Surgery of the Spine