Provider Demographics
NPI:1518941996
Name:KOUFMAN, JAMIE
Entity Type:Individual
Prefix:DR
First Name:JAMIE
Middle Name:
Last Name:KOUFMAN
Suffix:
Gender:F
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:200 WEST 57TH STREET, SUITE 1203
Mailing Address - Street 2:
Mailing Address - City:NEW YORK
Mailing Address - State:NY
Mailing Address - Zip Code:10019
Mailing Address - Country:US
Mailing Address - Phone:212-463-8014
Mailing Address - Fax:212-757-0677
Practice Address - Street 1:200 W 57TH ST
Practice Address - Street 2:SUITE 1203
Practice Address - City:NEW YORK
Practice Address - State:NY
Practice Address - Zip Code:10019-3211
Practice Address - Country:US
Practice Address - Phone:212-463-8014
Practice Address - Fax:212-757-0677
Is Sole Proprietor?:Yes
Enumeration Date:2005-11-30
Last Update Date:2010-02-02
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NC22759207Y00000X, 207YX0905X
NY2401221207Y00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207Y00000XAllopathic & Osteopathic PhysiciansOtolaryngology
No207YX0905XAllopathic & Osteopathic PhysiciansOtolaryngologyOtolaryngology/Facial Plastic Surgery
Provider Identifiers
StateIdentifier IDID TypeIssuer
C84987Medicare UPIN
NC2079711AMedicare ID - Type Unspecified