Basic Information
| Provider Information | |||||||||
| NPI: | 1386648616 | ||||||||
| EntityType: | 1 | ||||||||
| ReplacementNPI: | |||||||||
| OrganizationName: | |||||||||
| LastName: | KAUFMANN | ||||||||
| FirstName: | MARK | ||||||||
| MiddleName: | D. | ||||||||
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| Credential: | M.D. | ||||||||
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| Mailing Information | |||||||||
| Address1: | 151 SOUTHHALL LN STE 300 | ||||||||
| Address2: | |||||||||
| City: | MAITLAND | ||||||||
| State: | FL | ||||||||
| PostalCode: | 327517172 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 4079177293 | ||||||||
| FaxNumber: | 4076503455 | ||||||||
| Practice Location | |||||||||
| Address1: | 21 E 90TH ST | ||||||||
| Address2: | |||||||||
| City: | NEW YORK | ||||||||
| State: | NY | ||||||||
| PostalCode: | 101280654 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 2124274000 | ||||||||
| FaxNumber: | 2124106229 | ||||||||
| Other Information | |||||||||
| ProviderEnumerationDate: | 06/01/2005 | ||||||||
| LastUpdateDate: | 07/16/2021 | ||||||||
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| ProviderGenderCode: | M | ||||||||
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| IsSoleProprietor: | Y | ||||||||
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| NPICertificationDate: | 07/16/2021 | ||||||||
Taxonomy Information
| Taxonomy | License | State | Switch | TaxonomyGroup | TaxonomyType | TaxonomyClass | SubSpecialty | 207N00000X | BK3751460 | FL | N | Allopathic & Osteopathic Physicians | Dermatology | 207NS0135X | 178676-1 | NY | N | Allopathic & Osteopathic Physicians | Dermatology | Procedural Dermatology | 207NS0135X | ME146752 | FL | N | Allopathic & Osteopathic Physicians | Dermatology | Procedural Dermatology | 207N00000X | ME146752 | FL | Y | Allopathic & Osteopathic Physicians | Dermatology |
No ID Information.