Provider Demographics
NPI:1073528873
Name:KAFOZOFF, KARL HRISTOFF (PT, LAC)
Entity Type:Individual
Prefix:MR
First Name:KARL
Middle Name:HRISTOFF
Last Name:KAFOZOFF
Suffix:
Gender:M
Credentials:PT, LAC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:16 ANDREW DR
Mailing Address - Street 2:
Mailing Address - City:MONROE
Mailing Address - State:NJ
Mailing Address - Zip Code:08831-3539
Mailing Address - Country:US
Mailing Address - Phone:732-656-9495
Mailing Address - Fax:
Practice Address - Street 1:4241 HYLAN BLVD
Practice Address - Street 2:
Practice Address - City:STATEN ISLAND
Practice Address - State:NY
Practice Address - Zip Code:10312-6524
Practice Address - Country:US
Practice Address - Phone:718-490-1507
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2006-07-30
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY001478171100000X
NY023824225100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Not Answered171100000XOther Service ProvidersAcupuncturist
Not Answered225100000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical Therapist
Provider Identifiers
StateIdentifier IDID TypeIssuer
NYQP2831Medicare UPIN