Provider Demographics
NPI:1295950483
Name:ABRAHAM KUPERBERG, PH.D.
Entity type:Organization
Organization Name:ABRAHAM KUPERBERG, PH.D.
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PSYCHOLOGIST
Authorized Official - Prefix:DR
Authorized Official - First Name:ABRAHAM
Authorized Official - Middle Name:
Authorized Official - Last Name:KUPERBERG
Authorized Official - Suffix:
Authorized Official - Credentials:PHD
Authorized Official - Phone:845-627-1000
Mailing Address - Street 1:55 OLD TURNPIKE RD
Mailing Address - Street 2:SUITE 601
Mailing Address - City:NANUET
Mailing Address - State:NY
Mailing Address - Zip Code:10954-2461
Mailing Address - Country:US
Mailing Address - Phone:845-627-1000
Mailing Address - Fax:888-453-1609
Practice Address - Street 1:2-31 SUMMIT AVE
Practice Address - Street 2:
Practice Address - City:FAIR LAWN
Practice Address - State:NJ
Practice Address - Zip Code:07410-2043
Practice Address - Country:US
Practice Address - Phone:845-627-1000
Practice Address - Fax:888-453-1609
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2007-04-15
Last Update Date:2020-08-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY8419103T00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes103T00000XBehavioral Health & Social Service ProvidersPsychologistGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
NYV25272Medicare ID - Type UnspecifiedMEDICARE PROVIDER