Provider Demographics
NPI:1962402495
Name:KAUFMAN, JAY HOWARD (DPM)
Entity type:Individual
Prefix:DR
First Name:JAY
Middle Name:HOWARD
Last Name:KAUFMAN
Suffix:
Gender:M
Credentials:DPM
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:PO BOX 848269
Mailing Address - Street 2:
Mailing Address - City:BOSTON
Mailing Address - State:MA
Mailing Address - Zip Code:02284-8269
Mailing Address - Country:US
Mailing Address - Phone:610-973-1700
Mailing Address - Fax:610-973-1778
Practice Address - Street 1:250 CETRONIA RD
Practice Address - Street 2:SUITE 303
Practice Address - City:ALLENTOWN
Practice Address - State:PA
Practice Address - Zip Code:18104-9147
Practice Address - Country:US
Practice Address - Phone:610-973-6200
Practice Address - Fax:610-973-6546
Is Sole Proprietor?:No
Enumeration Date:2005-07-27
Last Update Date:2014-01-16
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
PASC-003737-L213ES0103X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes213ES0103XPodiatric Medicine & Surgery Service ProvidersPodiatristFoot & Ankle Surgery
Provider Identifiers
StateIdentifier IDID TypeIssuer
PW739579OtherBLUE SHIELD
PA0014614140003Medicaid
PA01203101OtherBLUE CROSS
U41307Medicare UPIN
PA0014614140003Medicaid
PA0866160001Medicare NSC