Basic Information
Provider Information
NPI: 1275504193
EntityType: 1
ReplacementNPI:  
OrganizationName:  
LastName: KAUFMAN
FirstName: SUSAN
MiddleName: I
NamePrefix:  
NameSuffix:  
Credential: D.O.
OtherOrganizationName:  
OtherOrganizationType:  
OtherLastName:  
OtherFirstName:  
OtherMiddleName:  
OtherNamePrefix:  
OtherNameSuffix:  
OtherCredential:  
OtherLastNameType:  
Mailing Information
Address1: PO BOX 536
Address2:  
City: VOORHEES
State: NJ
PostalCode: 080430536
CountryCode: US
TelephoneNumber: 8566696050
FaxNumber: 8566510794
Practice Location
Address1: 1930 STATE HWY 70 E
Address2: SUITE S-93
City: CHERRY HILL
State: NJ
PostalCode: 080032150
CountryCode: US
TelephoneNumber: 8564248091
FaxNumber: 8564240704
Other Information
ProviderEnumerationDate: 01/30/2006
LastUpdateDate: 11/28/2007
NPIDeactivationReasonCode:  
NPIDeactivationDate:  
NPIReactivationDate:  
ProviderGenderCode: F
AuthorizedOfficialLastName:  
AuthorizedOfficialFirstName:  
AuthorizedOfficialMiddleName:  
AuthorizedOfficialTitleorPosition:  
AuthorizedOfficialTelephone:  
IsSoleProprietor: N
IsOrganizationSubpart:  
ParentOrganizationLBN:  
AuthorizedOfficialNamePrefix:  
AuthorizedOfficialNameSuffix:  
AuthorizedOfficialCredential:  
NPICertificationDate:  

Taxonomy Information
TaxonomyLicenseStateSwitchTaxonomyGroupTaxonomyTypeTaxonomyClassSubSpecialty
207V00000XMB054186NJY Allopathic & Osteopathic PhysiciansObstetrics & Gynecology 

No ID Information.


Home