Provider Demographics
NPI:1003196171
Name:COFLER -KOLDORFF, MARA (MD)
Entity Type:Individual
Prefix:DR
First Name:MARA
Middle Name:
Last Name:COFLER -KOLDORFF
Suffix:
Gender:F
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:2915 SUNRISE HWY
Mailing Address - Street 2:
Mailing Address - City:ISLIP TERRACE
Mailing Address - State:NY
Mailing Address - Zip Code:11752-2716
Mailing Address - Country:US
Mailing Address - Phone:631-446-1006
Mailing Address - Fax:631-446-1009
Practice Address - Street 1:2915 SUNRISE HWY
Practice Address - Street 2:
Practice Address - City:ISLIP TERRACE
Practice Address - State:NY
Practice Address - Zip Code:11752-2716
Practice Address - Country:US
Practice Address - Phone:631-446-1006
Practice Address - Fax:631-446-1009
Is Sole Proprietor?:No
Enumeration Date:2011-08-22
Last Update Date:2011-08-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY262673207Q00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207Q00000XAllopathic & Osteopathic PhysiciansFamily Medicine