Provider Demographics
NPI:1508800954
Name:KOYFMAN, LILIYA (MD)
Entity Type:Individual
Prefix:DR
First Name:LILIYA
Middle Name:
Last Name:KOYFMAN
Suffix:
Gender:F
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:2756 POST RD
Mailing Address - Street 2:#100
Mailing Address - City:WARWICK
Mailing Address - State:RI
Mailing Address - Zip Code:02886-3003
Mailing Address - Country:US
Mailing Address - Phone:401-738-4300
Mailing Address - Fax:401-738-7718
Practice Address - Street 1:50 HEALTH LN
Practice Address - Street 2:
Practice Address - City:WARWICK
Practice Address - State:RI
Practice Address - Zip Code:02886-2711
Practice Address - Country:US
Practice Address - Phone:401-738-4300
Practice Address - Fax:401-738-7718
Is Sole Proprietor?:No
Enumeration Date:2006-06-16
Last Update Date:2023-03-07
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
RIMD9518174400000X
RIMD095182084P0800X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes2084P0800XAllopathic & Osteopathic PhysiciansPsychiatry & NeurologyPsychiatry
No174400000XOther Service ProvidersSpecialist
Provider Identifiers
StateIdentifier IDID TypeIssuer
RIMD9518OtherMD LICENSE
RI7006353Medicaid
RI15-05469OtherUBH PROVIDER ID
RI30113-6OtherBLUE CROSS PROVIDER ID
RI407215OtherBLUE CHIP PROVIDER ID
RI407215OtherBLUE CHIP PROVIDER ID
RI407215OtherBLUE CHIP PROVIDER ID
RI007006353Medicare PIN