Provider Demographics
NPI:1407816192
Name:KAUFFMAN, JAY D (PT)
Entity Type:Individual
Prefix:MR
First Name:JAY
Middle Name:D
Last Name:KAUFFMAN
Suffix:
Gender:M
Credentials:PT
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:33 DOUGLASS RD
Mailing Address - Street 2:
Mailing Address - City:LANSDALE
Mailing Address - State:PA
Mailing Address - Zip Code:19446-1450
Mailing Address - Country:US
Mailing Address - Phone:215-997-3951
Mailing Address - Fax:215-997-3951
Practice Address - Street 1:2767 GERYVILLE PIKE
Practice Address - Street 2:
Practice Address - City:PENNSBURG
Practice Address - State:PA
Practice Address - Zip Code:18073-2306
Practice Address - Country:US
Practice Address - Phone:215-679-0105
Practice Address - Fax:215-679-0722
Is Sole Proprietor?:Yes
Enumeration Date:2006-03-25
Last Update Date:2013-01-02
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
PAPT006662-L225100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225100000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical Therapist
Provider Identifiers
StateIdentifier IDID TypeIssuer
PA0017868680004Medicaid
PA076751Medicare ID - Type Unspecified