Healthcare Provider Details

I. General information

NPI: 1437413325
Provider Name (Legal Business Name): RIVKA KOFMAN
Entity Type: Individual
Gender: Female
Sole Proprietor: N

Provider Other Name: RIVKA REICH

II. Dates (important events)

Enumeration Date: 06/26/2012
Last Update Date: 06/26/2012
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1257 38TH ST
BROOKLYN NY
11218-1928
US

IV. Provider business mailing address

933 PARK AVE
LAKEWOOD NJ
08701-2053
US

V. Phone/Fax

Practice location:
  • Phone: 718-686-3700
  • Fax:
Mailing address:
  • Phone: 732-363-2212
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code174400000X
TaxonomySpecialist
License Number
License Number State

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: