Healthcare Provider Details

I. General information

NPI: 1437423704
Provider Name (Legal Business Name): ANASTASIYA KOFMAN M.S.
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 03/02/2012
Last Update Date: 10/08/2013
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

2419 E 73RD ST
BROOKLYN NY
11234-6623
US

IV. Provider business mailing address

2419 E 73RD ST
BROOKLYN NY
11234-6623
US

V. Phone/Fax

Practice location:
  • Phone: 347-374-1456
  • Fax:
Mailing address:
  • Phone: 347-374-1456
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code174400000X
TaxonomySpecialist
License Number563747111
License Number StateNY
# 2
Primary TaxonomyN
Taxonomy Code174400000X
TaxonomySpecialist
License Number563746111
License Number StateNY

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: