Healthcare Provider Details

I. General information

NPI: 1508800954
Provider Name (Legal Business Name): LILIYA KOYFMAN MD
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 06/16/2006
Last Update Date: 03/07/2023
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

50 HEALTH LN
WARWICK RI
02886-2711
US

IV. Provider business mailing address

2756 POST RD #100
WARWICK RI
02886-3003
US

V. Phone/Fax

Practice location:
  • Phone: 401-738-4300
  • Fax: 401-738-7718
Mailing address:
  • Phone: 401-738-4300
  • Fax: 401-738-7718

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code174400000X
TaxonomySpecialist
License NumberMD9518
License Number StateRI
# 2
Primary TaxonomyY
Taxonomy Code2084P0800X
TaxonomyPsychiatry Physician
License NumberMD09518
License Number StateRI

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: