Provider Demographics
NPI:1700252178
Name:KURPAKOV, EUGENE (FNP)
Entity Type:Individual
Prefix:MR
First Name:EUGENE
Middle Name:
Last Name:KURPAKOV
Suffix:
Gender:M
Credentials:FNP
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:341A HAROLD ST
Mailing Address - Street 2:
Mailing Address - City:STATEN ISLAND
Mailing Address - State:NY
Mailing Address - Zip Code:10314-4165
Mailing Address - Country:US
Mailing Address - Phone:646-671-2261
Mailing Address - Fax:
Practice Address - Street 1:966 CLOVE RD UNIT R
Practice Address - Street 2:
Practice Address - City:STATEN ISLAND
Practice Address - State:NY
Practice Address - Zip Code:10301-3630
Practice Address - Country:US
Practice Address - Phone:646-671-2261
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2015-08-19
Last Update Date:2023-01-27
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY706117163W00000X
NY350788363LF0000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LF0000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerFamily
No163W00000XNursing Service ProvidersRegistered Nurse