Provider Demographics
NPI:1093409609
Name:APOLLO MEDICAL DIAGNOSTICS
Entity Type:Organization
Organization Name:APOLLO MEDICAL DIAGNOSTICS
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:DR
Authorized Official - First Name:RICHARD
Authorized Official - Middle Name:C
Authorized Official - Last Name:KOFFLER
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:516-744-6933
Mailing Address - Street 1:44 BETHPAGE RD UNIT 3
Mailing Address - Street 2:
Mailing Address - City:HICKSVILLE
Mailing Address - State:NY
Mailing Address - Zip Code:11801-1538
Mailing Address - Country:US
Mailing Address - Phone:516-744-6933
Mailing Address - Fax:877-309-0329
Practice Address - Street 1:44 BETHPAGE RD UNIT 3
Practice Address - Street 2:
Practice Address - City:HICKSVILLE
Practice Address - State:NY
Practice Address - Zip Code:11801-1538
Practice Address - Country:US
Practice Address - Phone:516-744-6933
Practice Address - Fax:877-309-0329
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2023-06-06
Last Update Date:2023-06-06
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes2081P2900XAllopathic & Osteopathic PhysiciansPhysical Medicine & RehabilitationPain MedicineGroup - Single Specialty