Provider Demographics
NPI:1477624724
Name:KOFFMAN, MICHAEL ADAM (PHD)
Entity Type:Individual
Prefix:DR
First Name:MICHAEL
Middle Name:ADAM
Last Name:KOFFMAN
Suffix:
Gender:M
Credentials:PHD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:28 MILLBURN AVE
Mailing Address - Street 2:STE. 1
Mailing Address - City:SPRINGFIELD
Mailing Address - State:NJ
Mailing Address - Zip Code:07081-1039
Mailing Address - Country:US
Mailing Address - Phone:973-467-9333
Mailing Address - Fax:973-467-1145
Practice Address - Street 1:28 MILLBURN AVE
Practice Address - Street 2:STE. 1
Practice Address - City:SPRINGFIELD
Practice Address - State:NJ
Practice Address - Zip Code:07081-1039
Practice Address - Country:US
Practice Address - Phone:973-467-9333
Practice Address - Fax:973-467-1145
Is Sole Proprietor?:No
Enumeration Date:2006-11-10
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NJ041-A208101YM0800X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YM0800XBehavioral Health & Social Service ProvidersCounselorMental Health