Provider Demographics
NPI:1821091018
Name:KAUFMAN, SEAN L (DPM)
Entity Type:Individual
Prefix:DR
First Name:SEAN
Middle Name:L
Last Name:KAUFMAN
Suffix:
Gender:M
Credentials:DPM
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:528 BOULEVARD
Mailing Address - Street 2:
Mailing Address - City:KENILWORTH
Mailing Address - State:NJ
Mailing Address - Zip Code:07033-1657
Mailing Address - Country:US
Mailing Address - Phone:908-276-6624
Mailing Address - Fax:908-709-0163
Practice Address - Street 1:528 BOULEVARD
Practice Address - Street 2:
Practice Address - City:KENILWORTH
Practice Address - State:NJ
Practice Address - Zip Code:07033-1657
Practice Address - Country:US
Practice Address - Phone:908-276-6624
Practice Address - Fax:908-709-0163
Is Sole Proprietor?:No
Enumeration Date:2005-05-23
Last Update Date:2008-04-17
Deactivation Date:2006-03-17
Deactivation Code:
Reactivation Date:2006-03-29
Provider Licenses
StateLicense IDTaxonomies
NJMD002619213EP1101X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes213EP1101XPodiatric Medicine & Surgery Service ProvidersPodiatristPrimary Podiatric Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
NJ8719403Medicaid
NJ8719403Medicaid
NJ0521914Medicare PIN