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General NPI Number Information
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NPI Number | 1174800478
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Entity Type | Organization
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Legal Business Name | INTEGRATIVE MEDICAL WELLNESS PC
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Dates
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Enumeration Date | 11/15/2011
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Last Update Date | 11/15/2011
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Provider Practice Location Address
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Address Line | 99 BUSINESS PARK DR
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City | ARMONK
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State | NY
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Zip | 10504-1720
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Country | US
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Telephone | 917-903-4531
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Fax |
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Provider Business Mailing Address
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Address Line | 31 WOODMILL RD
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City | CHAPPAQUA
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State | NY
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Zip | 10514-1128
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Country | US
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Telephone | 917-903-4531
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Fax |
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Authorized Official
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Title or Position | PRINCIPAL
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Name | DR. RICHARD CARL KOFFLER
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Credential | M.D.
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Telephone | 917-903-4531
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 208100000X
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Taxonomy Name | Physical Medicine & Rehabilitation Physician
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License Number | 203547
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License Number State | NY
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