Provider Demographics
NPI:1760169262
Name:KOHN, RIFKY
Entity Type:Individual
Prefix:
First Name:RIFKY
Middle Name:
Last Name:KOHN
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 1:242 KEAP ST
Mailing Address - Street 2:
Mailing Address - City:BROOKLYN
Mailing Address - State:NY
Mailing Address - Zip Code:11211-7599
Mailing Address - Country:US
Mailing Address - Phone:718-804-3800
Mailing Address - Fax:
Practice Address - Street 1:242 KEAP ST
Practice Address - Street 2:
Practice Address - City:BROOKLYN
Practice Address - State:NY
Practice Address - Zip Code:11211-7599
Practice Address - Country:US
Practice Address - Phone:718-804-3800
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2023-06-28
Last Update Date:2023-06-28
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes171M00000XOther Service ProvidersCase Manager/Care Coordinator
Provider Identifiers
StateIdentifier IDID TypeIssuer
NYUG77340ZMedicaid