Healthcare Provider Details

I. General information

NPI: 1639244502
Provider Name (Legal Business Name): KOFINAS PERINATAL PC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 11/23/2006
Last Update Date: 09/19/2007
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

901 STEWART AVE SUITE 245
GARDEN CITY NY
11530-4893
US

IV. Provider business mailing address

86 ABBEY RD
MANHASSET NY
11030-2721
US

V. Phone/Fax

Practice location:
  • Phone: 516-832-0300
  • Fax: 516-832-0301
Mailing address:
  • Phone:
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code207VM0101X
TaxonomyMaternal & Fetal Medicine Physician
License Number155293
License Number StateNY

VIII. Authorized Official

Name: DR. ALEXANDER KOFINAS
Title or Position: PRESIDENT
Credential: M.D.
Phone: 516-832-0300