Healthcare Provider Details

I. General information

NPI: 1902030422
Provider Name (Legal Business Name): JASON D KOFINAS M.D.
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 05/12/2009
Last Update Date: 03/04/2025
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

65 BROADWAY FLOOR 14
NEW YORK NY
10006
US

IV. Provider business mailing address

65 BROADWAY FLOOR 14
NEW YORK NY
10006
US

V. Phone/Fax

Practice location:
  • Phone: 212-348-4000
  • Fax: 212-348-4001
Mailing address:
  • Phone: 212-348-4000
  • Fax: 212-348-4001

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code207VE0102X
TaxonomyReproductive Endocrinology Physician
License Number263117
License Number StateNY

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: