MEDICARE: MS. ANASTASIYA KOFMAN M.S.

Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

#	Taxonomy Code	Taxonomy	License Number	License Number State
1	174400000X	Specialist	563747111	NY
2	174400000X	Specialist	563746111	NY

General Provider Information

NPI Number	:	1437423704
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	MS. ANASTASIYA KOFMAN M.S.

Provider Business Mailing Address
First Line	:	2419 E 73RD ST
Second Line	:
City	:	BROOKLYN
State	:	NY
Zip	:	11234-6623
Country	:	US
Telephone Number	:	347-374-1456
Fax Number	:

Provider Business Practice Location Address
First Line	:	2419 E 73RD ST
Second Line	:
City	:	BROOKLYN
State	:	NY
Zip	:	11234-6623
Country	:	US
Telephone Number	:	347-374-1456
Fax Number	:

Authorized Official
Title or Position	:
Name	:
Credential	:
Telephone Number	:

Provider Enumeration Date	:	03/02/2012
Last Update Date	:	10/08/2013

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