Provider Demographics
NPI:1083609366
Name:KAUFMANN, WALTER ERNST (MD)
Entity Type:Individual
Prefix:DR
First Name:WALTER
Middle Name:ERNST
Last Name:KAUFMANN
Suffix:
Gender:M
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:20 GRAND STREET
Mailing Address - Street 2:3RD FLOOR
Mailing Address - City:WARWICK
Mailing Address - State:NY
Mailing Address - Zip Code:10990-1035
Mailing Address - Country:US
Mailing Address - Phone:845-987-3920
Mailing Address - Fax:845-987-5979
Practice Address - Street 1:161 E MAIN ST
Practice Address - Street 2:COMMUNITY MEDICAL CARE
Practice Address - City:PORT JERVIS
Practice Address - State:NY
Practice Address - Zip Code:12771-2113
Practice Address - Country:US
Practice Address - Phone:845-858-2666
Practice Address - Fax:845-858-2662
Is Sole Proprietor?:No
Enumeration Date:2005-09-13
Last Update Date:2010-09-24
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY149887207RC0000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207RC0000XAllopathic & Osteopathic PhysiciansInternal MedicineCardiovascular Disease
Provider Identifiers
StateIdentifier IDID TypeIssuer
NY00722656Medicaid
NY00722656Medicaid
76A361Medicare PIN
076A361Medicare ID - Type Unspecified