Healthcare Provider Details

I. General information

NPI: 1114927563
Provider Name (Legal Business Name): RICHARD TONY KAUFFMAN B.S., M.P.T
Entity Type: Individual
Gender: Male
Sole Proprietor: X

II. Dates (important events)

Enumeration Date: 07/28/2005
Last Update Date: 07/08/2007
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

123 FRANKLIN CORNER RD SUITE 103
LAWRENCEVILLE NJ
08648-2526
US

IV. Provider business mailing address

340 RUTGERS AVE
MERCERVILLE NJ
08619-2328
US

V. Phone/Fax

Practice location:
  • Phone: 609-896-9054
  • Fax: 609-896-9059
Mailing address:
  • Phone: 609-890-0871
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code225100000X
TaxonomyPhysical Therapist
License Number40QA00422900
License Number StateNJ

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: