=====================================================
General NPI Number Information
=====================================================
NPI Number | 1942341458
-----------------------------------------------------
Entity Type | Individual
-----------------------------------------------------
Provider Name | IRVING HENRY KAUFMAN MD
-----------------------------------------------------
Gender | Male
-----------------------------------------------------
=====================================================
Dates
=====================================================
Enumeration Date | 02/08/2007
-----------------------------------------------------
Last Update Date | 10/18/2011
-----------------------------------------------------
=====================================================
Provider Practice Location Address
=====================================================
Address Line | 1303 STATE ROUTE 27
-----------------------------------------------------
City | SOMERSET
-----------------------------------------------------
State | NJ
-----------------------------------------------------
Zip | 08873-3456
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 732-249-1500
-----------------------------------------------------
Fax | 732-249-8749
-----------------------------------------------------
=====================================================
Provider Business Mailing Address
=====================================================
Address Line | 73 LINCOLN AVE
-----------------------------------------------------
City | HIGHLAND PARK
-----------------------------------------------------
State | NJ
-----------------------------------------------------
Zip | 08904-1823
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 732-342-7365
-----------------------------------------------------
Fax | 732-249-8749
-----------------------------------------------------
=====================================================
Authorized Official
=====================================================
Title or Position |
-----------------------------------------------------
Name |
-----------------------------------------------------
Credential |
-----------------------------------------------------
Telephone |
-----------------------------------------------------
=====================================================
Scope of Practice (Provider's specialty)
=====================================================
Taxonomy #1
-----------------------------------------------------
Taxonomy Code | 207Q00000X
-----------------------------------------------------
Taxonomy Name | Family Medicine Physician
-----------------------------------------------------
License Number | 25MA04691800
-----------------------------------------------------
License Number State | NJ
-----------------------------------------------------
Taxonomy #2
-----------------------------------------------------
Taxonomy Code | 207QA0000X
-----------------------------------------------------
Taxonomy Name | Adolescent Medicine (Family Medicine) Physician
-----------------------------------------------------
License Number | 25MA04691800
-----------------------------------------------------
License Number State | NJ
-----------------------------------------------------
Taxonomy #3
-----------------------------------------------------
Taxonomy Code | 207QA0505X
-----------------------------------------------------
Taxonomy Name | Adult Medicine Physician
-----------------------------------------------------
License Number | 25MA04691800
-----------------------------------------------------
License Number State | NJ
-----------------------------------------------------
Taxonomy #4
-----------------------------------------------------
Taxonomy Code | 207QG0300X
-----------------------------------------------------
Taxonomy Name | Geriatric Medicine (Family Medicine) Physician
-----------------------------------------------------
License Number | 25MA04691800
-----------------------------------------------------
License Number State | NJ
-----------------------------------------------------