Healthcare Provider Details

I. General information

NPI: 1295190940
Provider Name (Legal Business Name): RIVKA KOFF
Entity Type: Individual
Gender: Female
Sole Proprietor: N

Provider Other Name: RIVKA WACHS

II. Dates (important events)

Enumeration Date: 12/23/2015
Last Update Date: 12/23/2015
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

386 ROUTE 59 SUITE 102
MONSEY NY
10952
US

IV. Provider business mailing address

130 EDISON CT APT B
MONSEY NY
10952-1945
US

V. Phone/Fax

Practice location:
  • Phone: 845-368-7927
  • Fax: 845-368-7929
Mailing address:
  • Phone: 845-213-8505
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code171M00000X
TaxonomyCase Manager/Care Coordinator
License Number
License Number State

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: