Provider Demographics
NPI:1093191207
Name:KAUFMAN, ELENI CHRISTINA
Entity Type:Individual
Prefix:
First Name:ELENI
Middle Name:CHRISTINA
Last Name:KAUFMAN
Suffix:
Gender:F
Credentials:
Other - Prefix:
Other - First Name:ELENI
Other - Middle Name:CHRISTINA
Other - Last Name:SOURES
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:PTA
Mailing Address - Street 1:366 HIGHLAND AVE
Mailing Address - Street 2:
Mailing Address - City:NORWALK
Mailing Address - State:CT
Mailing Address - Zip Code:06854-3413
Mailing Address - Country:US
Mailing Address - Phone:203-810-8668
Mailing Address - Fax:
Practice Address - Street 1:226 MILL HILL AVE
Practice Address - Street 2:
Practice Address - City:BRIDGEPORT
Practice Address - State:CT
Practice Address - Zip Code:06610-2826
Practice Address - Country:US
Practice Address - Phone:203-336-7301
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2015-08-11
Last Update Date:2015-08-11
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CT001502225200000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225200000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical Therapy Assistant