Provider Demographics
NPI:1700921491
Name:KAUFMAN, ELLIS JAY (PA-C)
Entity Type:Individual
Prefix:
First Name:ELLIS
Middle Name:JAY
Last Name:KAUFMAN
Suffix:
Gender:M
Credentials:PA-C
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:322 WARREN ST
Mailing Address - Street 2:SUITE 300
Mailing Address - City:JOHNSTOWN
Mailing Address - State:PA
Mailing Address - Zip Code:15905-3443
Mailing Address - Country:US
Mailing Address - Phone:814-288-4498
Mailing Address - Fax:814-288-5427
Practice Address - Street 1:322 WARREN ST
Practice Address - Street 2:SUITE 300
Practice Address - City:JOHNSTOWN
Practice Address - State:PA
Practice Address - Zip Code:15905-3443
Practice Address - Country:US
Practice Address - Phone:814-288-4498
Practice Address - Fax:814-288-5427
Is Sole Proprietor?:No
Enumeration Date:2007-02-20
Last Update Date:2013-12-19
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
PAMA002050L363AM0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363AM0700XPhysician Assistants & Advanced Practice Nursing ProvidersPhysician AssistantMedical