Provider Demographics
NPI:1568416675
Name:KOFSKY, WARREN (DPM)
Entity Type:Individual
Prefix:DR
First Name:WARREN
Middle Name:
Last Name:KOFSKY
Suffix:
Gender:M
Credentials:DPM
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:702 FAYETTE ST
Mailing Address - Street 2:
Mailing Address - City:CONSHOHOCKEN
Mailing Address - State:PA
Mailing Address - Zip Code:19428-1707
Mailing Address - Country:US
Mailing Address - Phone:610-825-1690
Mailing Address - Fax:610-825-1691
Practice Address - Street 1:702 FAYETTE ST
Practice Address - Street 2:
Practice Address - City:CONSHOHOCKEN
Practice Address - State:PA
Practice Address - Zip Code:19428-1707
Practice Address - Country:US
Practice Address - Phone:610-825-1690
Practice Address - Fax:610-825-1691
Is Sole Proprietor?:Yes
Enumeration Date:2006-05-22
Last Update Date:2010-07-13
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
PASC002242L213E00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes213E00000XPodiatric Medicine & Surgery Service ProvidersPodiatrist
Provider Identifiers
StateIdentifier IDID TypeIssuer
154503OtherHIGHMARK BLUE SHIELD
0048258000OtherHMO
T29715Medicare UPIN
154503Medicare ID - Type Unspecified