Healthcare Provider Details

I. General information

NPI: 1831402759
Provider Name (Legal Business Name): LISA ANN KAUFMAN RPT
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 07/20/2010
Last Update Date: 09/25/2026
Certification Date: 09/25/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

200 WHITE PLAINS RD STE 230
TARRYTOWN NY
10591-5838
US

IV. Provider business mailing address

15 CHESTER ST
ARDSLEY NY
10502-2518
US

V. Phone/Fax

Practice location:
  • Phone: 914-418-5266
  • Fax:
Mailing address:
  • Phone: 914-418-5266
  • Fax: 914-663-5315

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code2081P0010X
TaxonomyPediatric Rehabilitation Medicine Physician
License Number011623
License Number StateNY
# 2
Primary TaxonomyY
Taxonomy Code2251P0200X
TaxonomyPediatric Physical Therapist
License Number011623-1
License Number StateNY

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: