Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
Y | 207XS0117X | Orthopaedic Spine Surgeon | 25MA08778400 | NJ |
NPI | 1134379340 |
---|---|
Provider Name | Dr. Ilya Kupershtein |
First Address | Summit, NJ 07901-3563 |
Second Address | Summit, NJ 07901-3563 |
Gender | M |
NPI Entity type | Individual |
Is Sole Proprietor | Yes |
Is Organization Subpart | N/A |
Enumeration Date | 24/09/2008 |
Last Update Date | 24/11/2020 |