Provider Demographics
NPI:1780185744
Name:KOFFMAN, KIMBERLY (CNIM)
Entity Type:Individual
Prefix:
First Name:KIMBERLY
Middle Name:
Last Name:KOFFMAN
Suffix:
Gender:F
Credentials:CNIM
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:2516 HORSHAM RD
Mailing Address - Street 2:
Mailing Address - City:HATBORO
Mailing Address - State:PA
Mailing Address - Zip Code:19040-4343
Mailing Address - Country:US
Mailing Address - Phone:267-918-5318
Mailing Address - Fax:
Practice Address - Street 1:201 FLORAL VALE BLVD
Practice Address - Street 2:
Practice Address - City:YARDLEY
Practice Address - State:PA
Practice Address - Zip Code:19067-5524
Practice Address - Country:US
Practice Address - Phone:215-860-0100
Practice Address - Fax:215-860-2703
Is Sole Proprietor?:Yes
Enumeration Date:2018-02-26
Last Update Date:2018-02-26
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
2450246ZE0600X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes246ZE0600XTechnologists, Technicians & Other Technical Service ProvidersSpecialist/Technologist, OtherElectroneurodiagnostic