Provider Demographics
NPI:1528223252
Name:OUTPATIENT MANAGEMENT PHYSICIAN SVC POUGHKEEPSIE LLC
Entity Type:Organization
Organization Name:OUTPATIENT MANAGEMENT PHYSICIAN SVC POUGHKEEPSIE LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:DR
Authorized Official - First Name:BRUCE
Authorized Official - Middle Name:D
Authorized Official - Last Name:KAUFMAN
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:914-725-8855
Mailing Address - Street 1:5 PATRIOTS FARM PL
Mailing Address - Street 2:
Mailing Address - City:ARMONK
Mailing Address - State:NY
Mailing Address - Zip Code:10504-2810
Mailing Address - Country:US
Mailing Address - Phone:914-725-8855
Mailing Address - Fax:914-725-8877
Practice Address - Street 1:22 GREEN ST
Practice Address - Street 2:
Practice Address - City:POUGHKEEPSIE
Practice Address - State:NY
Practice Address - Zip Code:12601-1306
Practice Address - Country:US
Practice Address - Phone:914-725-8855
Practice Address - Fax:914-725-8877
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2008-07-22
Last Update Date:2008-07-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY147065207L00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes207L00000XAllopathic & Osteopathic PhysiciansAnesthesiologyGroup - Single Specialty