Provider Demographics
NPI:1437529955
Name:SUSAN I KAUFMAN DO PC
Entity Type:Organization
Organization Name:SUSAN I KAUFMAN DO PC
Other - Org Name:CENTER FOR SPECIALIZED GYNECOLOGY
Other - Org Type:Doing Business As
Authorized Official - Title/Position:PHYSICIAN
Authorized Official - Prefix:DR
Authorized Official - First Name:SUSAN
Authorized Official - Middle Name:I
Authorized Official - Last Name:KAUFMAN
Authorized Official - Suffix:
Authorized Official - Credentials:DO
Authorized Official - Phone:856-424-8091
Mailing Address - Street 1:1930 STATE HWY 70 E
Mailing Address - Street 2:SUITE S93 EXECUTIVE MEWS
Mailing Address - City:CHERRY HILL
Mailing Address - State:NJ
Mailing Address - Zip Code:08003-2150
Mailing Address - Country:US
Mailing Address - Phone:856-424-8091
Mailing Address - Fax:856-424-0704
Practice Address - Street 1:1930 STATE HWY 70 E
Practice Address - Street 2:SUITE S-93, EXECUTIVE MEWS
Practice Address - City:CHERRY HILL
Practice Address - State:NJ
Practice Address - Zip Code:08003-2150
Practice Address - Country:US
Practice Address - Phone:856-424-8091
Practice Address - Fax:856-424-0704
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2015-09-26
Last Update Date:2015-12-06
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NJMB54186207VG0400X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes207VG0400XAllopathic & Osteopathic PhysiciansObstetrics & GynecologyGynecologyGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
NJ455511Medicare PIN