Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
Y | 111NN1001X | Nutrition | X004157-1 | NY |
NPI | 1144367038 |
---|---|
Provider Name | Mr. Ronald Charles Kaufmann |
First Address | Rocky Point, NY 11778-8556 |
Second Address | Rocky Point, NY 11778-8556 |
Gender | M |
NPI Entity type | Individual |
Is Sole Proprietor | Yes |
Is Organization Subpart | N/A |
Enumeration Date | 31/01/2007 |
Last Update Date | 28/11/2011 |
IDENTIFIER | TYPE / CODE | IDENTIFIER STATE |
---|---|---|
6886K1 | EMHP BLUE CROSS (01) | NY |
69877 | YTRA HEALTH FOR ACU (01) | NY |