Provider Demographics
NPI:1497148373
Name:MICHELE D KOFMAN PSYCHOLOGIST PC
Entity Type:Organization
Organization Name:MICHELE D KOFMAN PSYCHOLOGIST PC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PRESIDENT
Authorized Official - Prefix:DR
Authorized Official - First Name:MICHELE
Authorized Official - Middle Name:
Authorized Official - Last Name:KOFMAN
Authorized Official - Suffix:
Authorized Official - Credentials:PHD MPH
Authorized Official - Phone:917-405-3991
Mailing Address - Street 1:210 W 70TH ST
Mailing Address - Street 2:SUITE 01
Mailing Address - City:NEW YORK
Mailing Address - State:NY
Mailing Address - Zip Code:10023-4304
Mailing Address - Country:US
Mailing Address - Phone:
Mailing Address - Fax:
Practice Address - Street 1:210 W 70TH ST
Practice Address - Street 2:SUITE 01
Practice Address - City:NEW YORK
Practice Address - State:NY
Practice Address - Zip Code:10023-4304
Practice Address - Country:US
Practice Address - Phone:917-405-3991
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2015-03-16
Last Update Date:2015-03-16
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY0178791261QM0850X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes261QM0850XAmbulatory Health Care FacilitiesClinic/CenterAdult Mental Health