MEDICARE: NANCY KOFF MFT

Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

#	Taxonomy Code	Taxonomy	License Number	License Number State
1	106H00000X	Marriage & Family Therapist

General Provider Information

NPI Number	:	1053522524
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	NANCY KOFF MFT

Provider Business Mailing Address
First Line	:	575 E BAY DR
Second Line	:
City	:	LONG BEACH
State	:	NY
Zip	:	11561-2409
Country	:	US
Telephone Number	:	516-431-6928
Fax Number	:	516-431-6928

Provider Business Practice Location Address
First Line	:	1918 BELLMORE AVE
Second Line	:
City	:	NORTH BELLMORE
State	:	NY
Zip	:	11710-5641
Country	:	US
Telephone Number	:	516-431-6928
Fax Number	:	516-431-6928

Authorized Official
Title or Position	:
Name	:
Credential	:
Telephone Number	:

Provider Enumeration Date	:	05/25/2007
Last Update Date	:	07/08/2007

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