Healthcare Provider Details

I. General information

NPI: 1083609366
Provider Name (Legal Business Name): WALTER ERNST KAUFMANN MD
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 09/13/2005
Last Update Date: 09/24/2010
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

161 E MAIN ST COMMUNITY MEDICAL CARE
PORT JERVIS NY
12771-2113
US

IV. Provider business mailing address

20 GRAND STREET 3RD FLOOR
WARWICK NY
10990-1035
US

V. Phone/Fax

Practice location:
  • Phone: 845-858-2666
  • Fax: 845-858-2662
Mailing address:
  • Phone: 845-987-3920
  • Fax: 845-987-5979

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code207RC0000X
TaxonomyCardiovascular Disease Physician
License Number149887
License Number StateNY

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: