Basic Information
| Provider Information | |||||||||
| NPI: | 1700921491 | ||||||||
| EntityType: | 1 | ||||||||
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| OrganizationName: | |||||||||
| LastName: | KAUFMAN | ||||||||
| FirstName: | ELLIS | ||||||||
| MiddleName: | JAY | ||||||||
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| Credential: | PA-C | ||||||||
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| Mailing Information | |||||||||
| Address1: | 322 WARREN ST | ||||||||
| Address2: | SUITE 300 | ||||||||
| City: | JOHNSTOWN | ||||||||
| State: | PA | ||||||||
| PostalCode: | 159053443 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 8142884498 | ||||||||
| FaxNumber: | 8142885427 | ||||||||
| Practice Location | |||||||||
| Address1: | 322 WARREN ST | ||||||||
| Address2: | SUITE 300 | ||||||||
| City: | JOHNSTOWN | ||||||||
| State: | PA | ||||||||
| PostalCode: | 159053443 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 8142884498 | ||||||||
| FaxNumber: | 8142885427 | ||||||||
| Other Information | |||||||||
| ProviderEnumerationDate: | 02/20/2007 | ||||||||
| LastUpdateDate: | 12/19/2013 | ||||||||
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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 | 363AM0700X | MA002050L | PA | Y | Physician Assistants & Advanced Practice Nursing Providers | Physician Assistant | Medical |
No ID Information.