Provider Demographics
NPI:1972782902
Name:SERGE I KAFTAL, M.D
Entity Type:Organization
Organization Name:SERGE I KAFTAL, M.D
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:MR
Authorized Official - First Name:SERGE
Authorized Official - Middle Name:
Authorized Official - Last Name:KAFTAL
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:973-200-4407
Mailing Address - Street 1:10 ANDERSON HILL RD
Mailing Address - Street 2:
Mailing Address - City:BERNARDSVILLE
Mailing Address - State:NJ
Mailing Address - Zip Code:07924-2323
Mailing Address - Country:US
Mailing Address - Phone:
Mailing Address - Fax:
Practice Address - Street 1:10 ANDERSON HILL RD
Practice Address - Street 2:
Practice Address - City:BERNARDSVILLE
Practice Address - State:NJ
Practice Address - Zip Code:07924-2323
Practice Address - Country:US
Practice Address - Phone:908-766-1223
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2007-10-26
Last Update Date:2007-10-26
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NJMA46768207Q00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes207Q00000XAllopathic & Osteopathic PhysiciansFamily MedicineGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
NJDD9664OtherRAILROAD MEDICARE
NJD92275Medicare UPIN
NJ095517Medicare PIN