Healthcare Provider Details

I. General information

NPI: 1609950161
Provider Name (Legal Business Name): NATALYA KOFMAN D.O.
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 10/24/2006
Last Update Date: 11/18/2025
Certification Date: 11/18/2025
Deactivation Date:
Reactivation Date:

III. Provider practice location address

2748 OCEAN AVE APT 6
BROOKLYN NY
11229-4735
US

IV. Provider business mailing address

4379 BEDFORD AVE
BROOKLYN NY
11229-4928
US

V. Phone/Fax

Practice location:
  • Phone: 718-376-1325
  • Fax: 718-376-0400
Mailing address:
  • Phone: 718-934-1353
  • Fax: 718-376-0400

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code208000000X
TaxonomyPediatrics Physician
License Number220659
License Number StateNY

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: