Provider Demographics
NPI:1114927563
Name:KAUFFMAN, RICHARD TONY (BS, MPT)
Entity Type:Individual
Prefix:MR
First Name:RICHARD
Middle Name:TONY
Last Name:KAUFFMAN
Suffix:
Gender:M
Credentials:BS, MPT
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:340 RUTGERS AVE
Mailing Address - Street 2:
Mailing Address - City:MERCERVILLE
Mailing Address - State:NJ
Mailing Address - Zip Code:08619-2328
Mailing Address - Country:US
Mailing Address - Phone:609-890-0871
Mailing Address - Fax:
Practice Address - Street 1:123 FRANKLIN CORNER RD
Practice Address - Street 2:SUITE 103
Practice Address - City:LAWRENCEVILLE
Practice Address - State:NJ
Practice Address - Zip Code:08648-2526
Practice Address - Country:US
Practice Address - Phone:609-896-9054
Practice Address - Fax:609-896-9059
Is Sole Proprietor?:Not Answered
Enumeration Date:2005-07-28
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NJ40QA00422900225100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225100000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical Therapist
Provider Identifiers
StateIdentifier IDID TypeIssuer
NJ445887Medicare ID - Type UnspecifiedGROUP NUMBER
NJ030802SY4Medicare ID - Type UnspecifiedPROVIDER NUMBER