Provider Demographics
NPI:1568437127
Name:JOFFY, SERGEI L (MD)
Entity Type:Individual
Prefix:
First Name:SERGEI
Middle Name:L
Last Name:JOFFY
Suffix:
Gender:M
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:755 NORMAN DRIVE
Mailing Address - Street 2:
Mailing Address - City:LEBANON
Mailing Address - State:PA
Mailing Address - Zip Code:17042-7497
Mailing Address - Country:US
Mailing Address - Phone:717-273-6706
Mailing Address - Fax:717-273-1435
Practice Address - Street 1:850 TUCK ST
Practice Address - Street 2:
Practice Address - City:LEBANON
Practice Address - State:PA
Practice Address - Zip Code:17042-7477
Practice Address - Country:US
Practice Address - Phone:717-272-8173
Practice Address - Fax:717-272-4029
Is Sole Proprietor?:No
Enumeration Date:2006-02-17
Last Update Date:2022-03-21
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
PAMD436262207RC0200X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207RC0200XAllopathic & Osteopathic PhysiciansInternal MedicineCritical Care Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
PA1023076810001Medicaid
PA50084689OtherCAPITAL BLUE CROSS
PAJO2104360OtherHIGHMARK BLUE SHIELD
PA155256FEUMedicare PIN
PAJO2104360OtherHIGHMARK BLUE SHIELD