Healthcare Provider Details

I. General information

NPI: 1720450695
Provider Name (Legal Business Name): RACHEL KOFSKY MA RD CSP CDN LDN
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 10/30/2015
Last Update Date: 04/02/2024
Certification Date: 04/02/2024
Deactivation Date:
Reactivation Date:

III. Provider practice location address

836 S FRONT ST
PHILADELPHIA PA
19147-4343
US

IV. Provider business mailing address

836 S FRONT ST
PHILADELPHIA PA
19147-4343
US

V. Phone/Fax

Practice location:
  • Phone: 914-393-6814
  • Fax:
Mailing address:
  • Phone: 914-393-6814
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code133VN1004X
TaxonomyPediatric Nutrition Registered Dietitian
License Number48 008291
License Number StateNY

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: