Provider Demographics
NPI:1740204361
Name:KAFTAL, SERGIUSZ I (MD)
Entity Type:Individual
Prefix:MR
First Name:SERGIUSZ
Middle Name:I
Last Name:KAFTAL
Suffix:
Gender:M
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:150 N FINLEY AVE # 207
Mailing Address - Street 2:
Mailing Address - City:BASKING RIDGE
Mailing Address - State:NJ
Mailing Address - Zip Code:07920-1686
Mailing Address - Country:US
Mailing Address - Phone:908-766-1223
Mailing Address - Fax:
Practice Address - Street 1:150 N FINLEY AVE # 207
Practice Address - Street 2:
Practice Address - City:BASKING RIDGE
Practice Address - State:NJ
Practice Address - Zip Code:07920-1686
Practice Address - Country:US
Practice Address - Phone:908-766-1223
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2006-07-27
Last Update Date:2023-12-26
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NJMA46768207Q00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207Q00000XAllopathic & Osteopathic PhysiciansFamily Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
223498100OtherBLUE CROSS
223498100OtherCIGNA
0464660001OtherAMERIHEALTH
0K3680OtherHEALTH NET
223498100OtherAETNA
NJP00263171OtherRAILROAD MEDICARE
22-3498100OtherTAX ID
223498100OtherAETNA
223498100OtherBLUE CROSS