MEDICARE: ELIAZ KAUFMAN DDS PLLC

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	1223P0300X	Periodontics	49860	NY
2	1223G0001X	General Practice Dentistry	49860	NY

General Provider Information

NPI Number	:	1992236103
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	ELIAZ KAUFMAN DDS PLLC

Provider Business Mailing Address
First Line	:	55 AVENUE C
Second Line	:	GROUND FLOOR
City	:	NEW YORK
State	:	NY
Zip	:	10009-6855
Country	:	US
Telephone Number	:
Fax Number	:

Provider Business Practice Location Address
First Line	:	55 AVENUE C
Second Line	:	GROUND FLOOR
City	:	NEW YORK
State	:	NY
Zip	:	10009-6855
Country	:	US
Telephone Number	:	201-310-0289
Fax Number	:

Authorized Official
Title or Position	:	OWNER
Name	:	DR. ELIAZ KAUFMAN
Credential	:	DDS MS
Telephone Number	:	201-310-0289

Provider Enumeration Date	:	03/21/2017
Last Update Date	:	03/21/2017

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