Provider Demographics
NPI:1699030353
Name:KAUFMAN, MASHI (TVI)
Entity Type:Individual
Prefix:MISS
First Name:MASHI
Middle Name:
Last Name:KAUFMAN
Suffix:
Gender:F
Credentials:TVI
Other - Prefix:MISS
Other - First Name:MASHI
Other - Middle Name:
Other - Last Name:KAUFMAN
Other - Suffix:
Other - Last Name Type:Professional Name
Other - Credentials:TVI
Mailing Address - Street 1:5619 14TH AVENUE
Mailing Address - Street 2:
Mailing Address - City:BROOKLYN
Mailing Address - State:NY
Mailing Address - Zip Code:11219
Mailing Address - Country:US
Mailing Address - Phone:718-972-3020
Mailing Address - Fax:
Practice Address - Street 1:5619 14TH AVE APT 2E
Practice Address - Street 2:
Practice Address - City:BROOKLYN
Practice Address - State:NY
Practice Address - Zip Code:11219-4612
Practice Address - Country:US
Practice Address - Phone:718-972-3020
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2012-07-09
Last Update Date:2012-07-09
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY000000000174400000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes174400000XOther Service ProvidersSpecialist
Provider Identifiers
StateIdentifier IDID TypeIssuer
NY000-00-0000OtherN/A