Provider Demographics
NPI:1437436177
Name:ARNOLD M KOFF, MD (DDA AVON HEALTH
Entity Type:Organization
Organization Name:ARNOLD M KOFF, MD (DDA AVON HEALTH
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:DR
Authorized Official - First Name:ARNOLD
Authorized Official - Middle Name:M
Authorized Official - Last Name:KOFF
Authorized Official - Suffix:
Authorized Official - Credentials:MD, FACP
Authorized Official - Phone:860-675-6595
Mailing Address - Street 1:30 W AVON RD
Mailing Address - Street 2:SUITE A
Mailing Address - City:AVON
Mailing Address - State:CT
Mailing Address - Zip Code:06001-3678
Mailing Address - Country:US
Mailing Address - Phone:860-675-6595
Mailing Address - Fax:860-673-6721
Practice Address - Street 1:30 W AVON RD
Practice Address - Street 2:SUITE A
Practice Address - City:AVON
Practice Address - State:CT
Practice Address - Zip Code:06001-3678
Practice Address - Country:US
Practice Address - Phone:860-675-6595
Practice Address - Fax:860-673-6721
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2011-11-09
Last Update Date:2016-08-25
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CT009481207RC0000X
CT002626363LF0000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes207RC0000XAllopathic & Osteopathic PhysiciansInternal MedicineCardiovascular DiseaseGroup - Single Specialty
No363LF0000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerFamilyGroup - Single Specialty