Provider Demographics
NPI:1023060878
Name:KAUFMAN, MERRILL C (DO)
Entity type:Individual
Prefix:DR
First Name:MERRILL
Middle Name:C
Last Name:KAUFMAN
Suffix:
Gender:M
Credentials:DO
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:9510 101ST AVE
Mailing Address - Street 2:
Mailing Address - City:OZONE PARK
Mailing Address - State:NY
Mailing Address - Zip Code:11416-2518
Mailing Address - Country:US
Mailing Address - Phone:718-835-3800
Mailing Address - Fax:718-641-3802
Practice Address - Street 1:9510 101ST AVE
Practice Address - Street 2:
Practice Address - City:OZONE PARK
Practice Address - State:NY
Practice Address - Zip Code:11416-2518
Practice Address - Country:US
Practice Address - Phone:718-835-3800
Practice Address - Fax:718-641-3802
Is Sole Proprietor?:Yes
Enumeration Date:2006-05-17
Last Update Date:2019-07-26
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY138339-1207R00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207R00000XAllopathic & Osteopathic PhysiciansInternal Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
NYD79296Medicare UPIN
NY0024219Medicare ID - Type Unspecified