1992788012 NPI number — SUSAN M KAUFMAN DO

Table of content: (NPI 1992788012)

General

This information contains only most important part of the NPI data, for complete information, including NPI referencing materials please refer to 1992788012 NPI number — SUSAN M KAUFMAN DO

Organization/Personal Information

Employer Identification Number (EIN):
Provider Organization Name:
SUSAN M KAUFMAN DO
Provider Last Name:
Provider First Name:
Provider Middle Name:
Provider Name Prefix Text:
Provider Name Suffix Text:
Provider Credential Text:
Provider Gender Code:

Provider's Other Name Information

Provider Other Organization Name:
Provider Other Organization Name Type Code:
Provider Other Last Name:
Provider Other First Name:
Provider Other Middle Name:
Provider Other Name Prefix Text:
Provider Other Name Suffix Text:
Provider Other Credential Text:
Provider Other Last Name Type Code:

NPI Number Information

NPI Number:
1992788012
Entity Type Code:
Organization
Replacement NPI:
Last Update Date:
07/11/2007
NPI Deactivation Reason Code:
NPI Deactivation Date:
NPI Reactivation Date:

Provider's Business Mailing Address

Provider First Line Business Mailing Address:
300 YORK ST
Provider Second Line Business Mailing Address:
SUITE B
Provider Business Mailing Address City Name:
CORRY
Provider Business Mailing Address State Name:
PA
Provider Business Mailing Address Postal Code:
16407-1420
Provider Business Mailing Address Country Code:
US
Provider Business Mailing Address Telephone Number:
814-664-3979
Provider Business Mailing Address Fax Number:
814-663-4879

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
300 YORK ST
Provider Second Line Business Practice Location Address:
SUITE B
Provider Business Practice Location Address City Name:
CORRY
Provider Business Practice Location Address State Name:
PA
Provider Business Practice Location Address Postal Code:
16407-1420
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
814-664-3979
Provider Business Practice Location Address Fax Number:
814-663-4879
Provider Enumeration Date:
11/22/2005

Additional Information

Authorized Official

Authorized Official Last Name:
KAUFMAN
Authorized Official First Name:
BRUCE
Authorized Official Middle Name:
Authorized Official Title or Position:
OFFICE MANAGER
Authorized Official Telephone Number:
814-664-3979

Provider Taxonomy Codes

  • Taxonomy code: 207Q00000X , with the licence number:  OS006866L , registered in the state of PA ; information, associated with the NPI states the following Primary Taxonomy Switch: "Y" .

Other Provider's Identifiers (legacy, non-NPI)

  • Identifier: 1053316489 . This is a "NPI NUMBER" identifier , issued by the state of ( PA ) . This identifiers is of the category "OTHER".




Copyright © 2007-2025 www.npivalidator.com