Healthcare Provider Details

I. General information

NPI: 1336372523
Provider Name (Legal Business Name): MARVIN SAUL KOFF M.D.
Entity Type: Individual
Gender: Male
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 09/03/2009
Last Update Date: 09/03/2009
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

4 ASHTON CIR
SIMSBURY CT
06070-3184
US

IV. Provider business mailing address

4 ASHTON CIR
SIMSBURY CT
06070-3184
US

V. Phone/Fax

Practice location:
  • Phone: 860-651-3003
  • Fax:
Mailing address:
  • Phone: 860-651-3003
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code2084P0800X
TaxonomyPsychiatry Physician
License Number011876
License Number StateCT

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: