Provider Demographics
NPI:1609950161
Name:KOFMAN, NATALYA (DO)
Entity Type:Individual
Prefix:DR
First Name:NATALYA
Middle Name:
Last Name:KOFMAN
Suffix:
Gender:F
Credentials:DO
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:4379 BEDFORD AVE
Mailing Address - Street 2:
Mailing Address - City:BROOKLYN
Mailing Address - State:NY
Mailing Address - Zip Code:11229-4928
Mailing Address - Country:US
Mailing Address - Phone:718-934-1353
Mailing Address - Fax:718-376-0400
Practice Address - Street 1:2166 E 18TH ST
Practice Address - Street 2:
Practice Address - City:BROOKLYN
Practice Address - State:NY
Practice Address - Zip Code:11229-4406
Practice Address - Country:US
Practice Address - Phone:718-376-1325
Practice Address - Fax:718-376-0400
Is Sole Proprietor?:Yes
Enumeration Date:2006-10-24
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY220659208000000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes208000000XAllopathic & Osteopathic PhysiciansPediatrics
Provider Identifiers
StateIdentifier IDID TypeIssuer
NY02364450Medicaid
522Z81Medicare ID - Type Unspecified
NYI00508Medicare UPIN