MEDICARE: MS. IRIS ANN KAUFMAN APRN, BC, FNP

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	363LF0000X	Family Nurse Practitioner	F333804	NY

General Provider Information

NPI Number	:	1992887277
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	MS. IRIS ANN KAUFMAN APRN, BC, FNP

Provider Business Mailing Address
First Line	:	75-42 255 STREET
Second Line	:
City	:	GLEN OAKS
State	:	NY
Zip	:	11040-1839
Country	:	US
Telephone Number	:	718-413-5879
Fax Number	:

Provider Business Practice Location Address
First Line	:	450 C LAKEVILLE ROAD
Second Line	:
City	:	LAKE SUCCESS
State	:	NY
Zip	:	11042-2810
Country	:	US
Telephone Number	:	516-734-8070
Fax Number	:	516-734-8075

Authorized Official
Title or Position	:
Name	:
Credential	:
Telephone Number	:

Provider Enumeration Date	:	10/19/2006
Last Update Date	:	03/01/2012

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