Provider Demographics
NPI:1043642887
Name:KUPERMAN, MARINA (FNP)
Entity type:Individual
Prefix:MRS
First Name:MARINA
Middle Name:
Last Name:KUPERMAN
Suffix:
Gender:F
Credentials:FNP
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:4768 HYLAN BLVD
Mailing Address - Street 2:
Mailing Address - City:STATEN ISLAND
Mailing Address - State:NY
Mailing Address - Zip Code:10312-6314
Mailing Address - Country:US
Mailing Address - Phone:718-753-3207
Mailing Address - Fax:
Practice Address - Street 1:350 91ST ST STE 1A
Practice Address - Street 2:
Practice Address - City:BROOKLYN
Practice Address - State:NY
Practice Address - Zip Code:11209-5853
Practice Address - Country:US
Practice Address - Phone:718-355-9705
Practice Address - Fax:718-355-8466
Is Sole Proprietor?:Yes
Enumeration Date:2013-08-03
Last Update Date:2024-08-06
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NYF3374991363LX0001X
NYF337499363LP2300X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes363LP2300XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerPrimary Care
No363LX0001XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerObstetrics & GynecologyGroup - Single Specialty