Provider Demographics
NPI:1952961179
Name:HERALD SQUARE MEDICAL WELLNESS PC
Entity Type:Organization
Organization Name:HERALD SQUARE MEDICAL WELLNESS PC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PRESIDENT
Authorized Official - Prefix:DR
Authorized Official - First Name:RICHARD
Authorized Official - Middle Name:
Authorized Official - Last Name:KOFFLER
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:646-454-8264
Mailing Address - Street 1:45 W 34TH ST RM 1201
Mailing Address - Street 2:
Mailing Address - City:NEW YORK
Mailing Address - State:NY
Mailing Address - Zip Code:10001-3124
Mailing Address - Country:US
Mailing Address - Phone:646-454-8264
Mailing Address - Fax:855-312-6352
Practice Address - Street 1:45 W 34TH ST RM 1201
Practice Address - Street 2:
Practice Address - City:NEW YORK
Practice Address - State:NY
Practice Address - Zip Code:10001-3124
Practice Address - Country:US
Practice Address - Phone:646-454-8264
Practice Address - Fax:855-312-6352
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2019-06-19
Last Update Date:2019-06-19
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes208100000XAllopathic & Osteopathic PhysiciansPhysical Medicine & RehabilitationGroup - Multi-Specialty