Healthcare Provider Details

I. General information

NPI: 1659575405
Provider Name (Legal Business Name): JEREMY D. KAUFMAN MD
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 06/14/2007
Last Update Date: 01/14/2019
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

160 HAWLEY LN UROLOGICAL ASSOCIATES OF BPT P.C.
TRUMBULL CT
06611-5300
US

IV. Provider business mailing address

160 HAWLEY LN SUITE 002
TRUMBULL CT
06611-5300
US

V. Phone/Fax

Practice location:
  • Phone: 203-375-3456
  • Fax: 203-375-4456
Mailing address:
  • Phone: 203-375-3456
  • Fax: 203-375-4456

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code2088P0231X
TaxonomyPediatric Urology Physician
License Number46705
License Number StateCT
# 2
Primary TaxonomyY
Taxonomy Code208800000X
TaxonomyUrology Physician
License Number46705
License Number StateCT

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: