Provider Demographics
NPI:1770578098
Name:KUPCHIK, SIMON GABRIEL (MD)
Entity type:Individual
Prefix:MR
First Name:SIMON
Middle Name:GABRIEL
Last Name:KUPCHIK
Suffix:
Gender:M
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
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Other - Credentials:
Mailing Address - Street 1:977 48TH STREET
Mailing Address - Street 2:
Mailing Address - City:BROOKLYN
Mailing Address - State:NY
Mailing Address - Zip Code:11219
Mailing Address - Country:US
Mailing Address - Phone:718-283-7229
Mailing Address - Fax:718-635-6331
Practice Address - Street 1:948 48TH STREET
Practice Address - Street 2:
Practice Address - City:BROOKLYN
Practice Address - State:NY
Practice Address - Zip Code:11219
Practice Address - Country:US
Practice Address - Phone:718-283-8260
Practice Address - Fax:718-283-6147
Is Sole Proprietor?:No
Enumeration Date:2005-09-13
Last Update Date:2014-02-13
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY176882207SG0201X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207SG0201XAllopathic & Osteopathic PhysiciansMedical GeneticsClinical Genetics (M.D.)
Provider Identifiers
StateIdentifier IDID TypeIssuer
NY01283861Medicaid
NY176882-B15OtherHEALTH FIRST
NY2423247OtherAETNA USHC HMO
NY68N0081OtherNEIGHBORHOOD HEALTH
NY113491197OtherMULTIPLAN
NY1491411OtherUNITED HEALTH CARE
NY4609674OtherAETNA PPO
NY113491197OtherHORIZON HEALTHCARE NY
NYBK00818-02OtherAMERICHOICE
NYP2103443OtherOXFORD HEALTH PLANS
NY113491197OtherPHCS
NY176882OtherHIP
NY1B0001OtherEMPIRE BCBS
NY2601597OtherGHI
NY4C0555OtherHEALTH NET
NYKG6882OtherATLANTIS HEALTH PLAN
NY258990201OtherHEALTH PLUS
NY2423247OtherAETNA USHC HMO
NY4609674OtherAETNA PPO