Healthcare Provider Details

I. General information

NPI: 1083789234
Provider Name (Legal Business Name): STEPHAN A KOHLHOFF M.D.
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 11/22/2006
Last Update Date: 07/08/2007
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

450 CLARKSON AVE SUNY DOWNSTATE MEDICAL CENTER, BOX 49
BROOKLYN NY
11203-2056
US

IV. Provider business mailing address

450 CLARKSON AVE SUNY DOWNSTATE MEDICAL CENTER, BOX 49
BROOKLYN NY
11203-2056
US

V. Phone/Fax

Practice location:
  • Phone: 718-622-5270
  • Fax: 718-270-3210
Mailing address:
  • Phone: 718-622-5270
  • Fax: 718-270-3210

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code2080P0208X
TaxonomyPediatric Infectious Diseases Physician
License Number002708
License Number StateNY

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: