Healthcare Provider Details

I. General information

NPI: 1518576842
Provider Name (Legal Business Name): MOLLY EVE SKOFF PA-C
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 07/22/2020
Last Update Date: 09/11/2020
Certification Date: 09/11/2020
Deactivation Date:
Reactivation Date:

III. Provider practice location address

5 E 98TH ST
NEW YORK NY
10029-6501
US

IV. Provider business mailing address

28 BUCKMINSTER RD
BROOKLINE MA
02445-5821
US

V. Phone/Fax

Practice location:
  • Phone: 212-241-6500
  • Fax:
Mailing address:
  • Phone: 617-780-2448
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code363AM0700X
TaxonomyMedical Physician Assistant
License Number025234
License Number StateNY

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: