MEDICARE: KAUFMAN AND SHMUELY DDS, PC

Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

#	Taxonomy Code	Taxonomy	License Number	License Number State
1	1223G0001X	General Practice Dentistry		NY
2	1223P0300X	Periodontics		NY

General Provider Information

NPI Number	:	1821437674
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	KAUFMAN AND SHMUELY DDS, PC

Provider Business Mailing Address
First Line	:	286 MADISON AVE
Second Line	:	SUITE 500, 5TH FLOOR
City	:	NEW YORK
State	:	NY
Zip	:	10016
Country	:	US
Telephone Number	:	212-682-2060
Fax Number	:

Provider Business Practice Location Address
First Line	:	286 MADISON AVE
Second Line	:	5TH FLOOR
City	:	NEW YORK
State	:	NY
Zip	:	10017-6345
Country	:	US
Telephone Number	:	212-682-2060
Fax Number	:

Authorized Official
Title or Position	:	OWNER/PERIODONTIST
Name	:	DR. ELIAZ KAUFMAN
Credential	:	DDS MS
Telephone Number	:	212-682-2060

Provider Enumeration Date	:	06/14/2013
Last Update Date	:	08/08/2013

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