Healthcare Provider Details

I. General information

NPI: 1437436177
Provider Name (Legal Business Name): ARNOLD M KOFF, MD (DDA AVON HEALTH
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 11/09/2011
Last Update Date: 08/25/2016
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

30 W AVON RD SUITE A
AVON CT
06001-3678
US

IV. Provider business mailing address

30 W AVON RD SUITE A
AVON CT
06001-3678
US

V. Phone/Fax

Practice location:
  • Phone: 860-675-6595
  • Fax: 860-673-6721
Mailing address:
  • Phone: 860-675-6595
  • Fax: 860-673-6721

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code207RC0000X
TaxonomyCardiovascular Disease Physician
License Number009481
License Number StateCT
# 2
Primary TaxonomyN
Taxonomy Code363LF0000X
TaxonomyFamily Nurse Practitioner
License Number002626
License Number StateCT

VIII. Authorized Official

Name: DR. ARNOLD M KOFF
Title or Position: OWNER
Credential: M.D., FACP
Phone: 860-675-6595