Healthcare Provider Details

I. General information

NPI: 1568437127
Provider Name (Legal Business Name): SERGEI L JOFFY MD
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 02/17/2006
Last Update Date: 03/21/2022
Certification Date: 03/21/2022
Deactivation Date:
Reactivation Date:

III. Provider practice location address

850 TUCK ST
LEBANON PA
17042-7477
US

IV. Provider business mailing address

755 NORMAN DRIVE
LEBANON PA
17042-7497
US

V. Phone/Fax

Practice location:
  • Phone: 717-272-8173
  • Fax: 717-272-4029
Mailing address:
  • Phone: 717-273-6706
  • Fax: 717-273-1435

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code207RC0200X
TaxonomyCritical Care Medicine (Internal Medicine) Physician
License NumberMD436262
License Number StatePA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: