Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
Y | 1223G0001X | General Practice | DS019172L | PA |
Y | 213EG0000X | General Practice | DS019172L | PA |
NPI | 1003877358 |
---|---|
Provider Name | Myron Joel Kaufman |
First Address | N Versailles, PA 15137-2706 |
Second Address | N Versailles, PA 15137-2706 |
Gender | M |
NPI Entity type | Individual |
Is Sole Proprietor | No |
Is Organization Subpart | N/A |
Enumeration Date | 28/03/2006 |
Last Update Date | 09/07/2007 |
IDENTIFIER | TYPE / CODE | IDENTIFIER STATE |
---|---|---|
0005266860002 | (05) | PA |
046432 | UNITED CONCORDIA DENTAL (01) | PA |