Provider Demographics
NPI:1336372523
Name:KOFF, MARVIN SAUL (MD)
Entity Type:Individual
Prefix:
First Name:MARVIN
Middle Name:SAUL
Last Name:KOFF
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 1:4 ASHTON CIR
Mailing Address - Street 2:
Mailing Address - City:SIMSBURY
Mailing Address - State:CT
Mailing Address - Zip Code:06070-3184
Mailing Address - Country:US
Mailing Address - Phone:860-651-3003
Mailing Address - Fax:
Practice Address - Street 1:4 ASHTON CIR
Practice Address - Street 2:
Practice Address - City:SIMSBURY
Practice Address - State:CT
Practice Address - Zip Code:06070-3184
Practice Address - Country:US
Practice Address - Phone:860-651-3003
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2009-09-03
Last Update Date:2009-09-03
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CT0118762084P0800X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes2084P0800XAllopathic & Osteopathic PhysiciansPsychiatry & NeurologyPsychiatry