Provider Demographics
NPI:1942341458
Name:KAUFMAN, IRVING HENRY (MD)
Entity Type:Individual
Prefix:
First Name:IRVING
Middle Name:HENRY
Last Name:KAUFMAN
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 1:73 LINCOLN AVE
Mailing Address - Street 2:
Mailing Address - City:HIGHLAND PARK
Mailing Address - State:NJ
Mailing Address - Zip Code:08904-1823
Mailing Address - Country:US
Mailing Address - Phone:732-342-7365
Mailing Address - Fax:732-249-8749
Practice Address - Street 1:1303 STATE ROUTE 27
Practice Address - Street 2:
Practice Address - City:SOMERSET
Practice Address - State:NJ
Practice Address - Zip Code:08873-3456
Practice Address - Country:US
Practice Address - Phone:732-249-1500
Practice Address - Fax:732-249-8749
Is Sole Proprietor?:Yes
Enumeration Date:2007-02-08
Last Update Date:2011-10-18
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NJ25MA04691800207Q00000X, 207QA0000X, 207QA0505X, 207QG0300X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207Q00000XAllopathic & Osteopathic PhysiciansFamily Medicine
No207QA0000XAllopathic & Osteopathic PhysiciansFamily MedicineAdolescent Medicine
No207QA0505XAllopathic & Osteopathic PhysiciansFamily MedicineAdult Medicine
No207QG0300XAllopathic & Osteopathic PhysiciansFamily MedicineGeriatric Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
NJ3316203Medicaid
NJ3316203Medicaid
NJD18877Medicare UPIN