Healthcare Provider Details

I. General information

NPI: 1497148373
Provider Name (Legal Business Name): MICHELE D KOFMAN PSYCHOLOGIST PC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 03/16/2015
Last Update Date: 03/16/2015
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

210 W 70TH ST SUITE 01
NEW YORK NY
10023-4304
US

IV. Provider business mailing address

210 W 70TH ST SUITE 01
NEW YORK NY
10023-4304
US

V. Phone/Fax

Practice location:
  • Phone: 917-405-3991
  • Fax:
Mailing address:
  • Phone:
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code261QM0850X
TaxonomyAdult Mental Health Clinic/Center
License Number0178791
License Number StateNY

VIII. Authorized Official

Name: DR. MICHELE KOFMAN
Title or Position: PRESIDENT
Credential: PHD MPH
Phone: 917-405-3991