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General NPI Number Information
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NPI Number | 1255499513
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Entity Type | Individual
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Provider Name | JEFFREY MICHAEL KOFFLER MD
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Gender | Male
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Dates
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Enumeration Date | 12/05/2006
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Last Update Date | 03/29/2016
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Provider Practice Location Address
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Address Line | 39 GLENBROOK RD 1G
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City | STAMFORD
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State | CT
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Zip | 06902-2968
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Country | US
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Telephone | 203-323-2500
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Fax | 203-323-3003
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Provider Business Mailing Address
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Address Line | 39 GLENBROOK RD 1G
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City | STAMFORD
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State | CT
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Zip | 06902-2968
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Country | US
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Telephone | 203-323-2500
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Fax | 203-323-3003
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Authorized Official
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Title or Position |
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Name |
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Credential |
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Telephone |
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 2084P0800X
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Taxonomy Name | Psychiatry Physician
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License Number | 021760
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License Number State | CT
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Taxonomy #2
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Taxonomy Code | 2084P0804X
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Taxonomy Name | Child & Adolescent Psychiatry Physician
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License Number | 137114
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License Number State | NY
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