Basic Information
| Provider Information | |||||||||
| NPI: | 1568633949 | ||||||||
| EntityType: | 1 | ||||||||
| ReplacementNPI: | |||||||||
| OrganizationName: | |||||||||
| LastName: | KAUFMAN | ||||||||
| FirstName: | ANDREW | ||||||||
| MiddleName: | RUSSELL | ||||||||
| NamePrefix: | DR. | ||||||||
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| Credential: | M.D. | ||||||||
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| Mailing Information | |||||||||
| Address1: | 7313 WAKEFIELD DR | ||||||||
| Address2: | |||||||||
| City: | FAYETTEVILLE | ||||||||
| State: | NY | ||||||||
| PostalCode: | 130669769 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 9196380659 | ||||||||
| FaxNumber: | 3156633054 | ||||||||
| Practice Location | |||||||||
| Address1: | 750 E ADAMS ST | ||||||||
| Address2: | |||||||||
| City: | SYRACUSE | ||||||||
| State: | NY | ||||||||
| PostalCode: | 132102342 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 3154643104 | ||||||||
| FaxNumber: | 3154647188 | ||||||||
| Other Information | |||||||||
| ProviderEnumerationDate: | 03/13/2008 | ||||||||
| LastUpdateDate: | 06/08/2017 | ||||||||
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| ProviderGenderCode: | M | ||||||||
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| IsSoleProprietor: | N | ||||||||
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Taxonomy Information
| Taxonomy | License | State | Switch | TaxonomyGroup | TaxonomyType | TaxonomyClass | SubSpecialty | 2084P0800X | 252397 | NY | Y | Allopathic & Osteopathic Physicians | Psychiatry & Neurology | Psychiatry | 2084F0202X | 252397 | NY | N | Allopathic & Osteopathic Physicians | Psychiatry & Neurology | Forensic Psychiatry |
No ID Information.