Basic Information
| Provider Information | |||||||||
| NPI: | 1023072063 | ||||||||
| EntityType: | 2 | ||||||||
| ReplacementNPI: | |||||||||
| OrganizationName: | ALDERFER AND KUPERSMITH ASSOCIATES | ||||||||
| LastName: | |||||||||
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| OtherOrganizationName: | STONERIDGE OB/GYN | ||||||||
| OtherOrganizationType: | 3 | ||||||||
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| Mailing Information | |||||||||
| Address1: | 670 LAWN AVE | ||||||||
| Address2: | SUITE 4 | ||||||||
| City: | SELLERSVILLE | ||||||||
| State: | PA | ||||||||
| PostalCode: | 189601571 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 2152570414 | ||||||||
| FaxNumber: | 2152571740 | ||||||||
| Practice Location | |||||||||
| Address1: | 670 LAWN AVE | ||||||||
| Address2: | SUITE 4 | ||||||||
| City: | SELLERSVILLE | ||||||||
| State: | PA | ||||||||
| PostalCode: | 189601571 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 2152570414 | ||||||||
| FaxNumber: | 2152571740 | ||||||||
| Other Information | |||||||||
| ProviderEnumerationDate: | 04/14/2006 | ||||||||
| LastUpdateDate: | 08/22/2020 | ||||||||
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| AuthorizedOfficialLastName: | KUPERSMITH | ||||||||
| AuthorizedOfficialFirstName: | STEPHEN | ||||||||
| AuthorizedOfficialMiddleName: | J | ||||||||
| AuthorizedOfficialTitleorPosition: | MD | ||||||||
| AuthorizedOfficialTelephone: | 2152570414 | ||||||||
| IsSoleProprietor: | |||||||||
| IsOrganizationSubpart: | N | ||||||||
| ParentOrganizationLBN: | |||||||||
| AuthorizedOfficialNamePrefix: | DR. | ||||||||
| AuthorizedOfficialNameSuffix: | |||||||||
| AuthorizedOfficialCredential: | MD | ||||||||
| NPICertificationDate: | |||||||||
Taxonomy Information
| Taxonomy | License | State | Switch | TaxonomyGroup | TaxonomyType | TaxonomyClass | SubSpecialty | 207V00000X | Y | 193400000X MULTIPLE SINGLE SPECIALTY GROUP | Allopathic & Osteopathic Physicians | Obstetrics & Gynecology |
ID Information
| ID | Type | State | Issuer | Description | 6348 | 01 | PA | AETNA | OTHER | 1000699 | 01 | PA | OTHER HMO | OTHER | G30388 | 01 | PA | MICHAEL CHMIELEWSKI | OTHER | 0021886000 | 01 | PA | INDEPENDENCE BLUE CROSS | OTHER |