1508800954 NPI number — DR. LILIYA KOYFMAN MD

Table of content: DR. LILIYA KOYFMAN MD (NPI 1508800954)

General

This information contains only most important part of the NPI data, for complete information, including NPI referencing materials please refer to 1508800954 NPI number — DR. LILIYA KOYFMAN MD

Organization/Personal Information

Employer Identification Number (EIN):
Provider Organization Name:
Provider Last Name:
KOYFMAN
Provider First Name:
LILIYA
Provider Middle Name:
Provider Name Prefix Text:
DR.
Provider Name Suffix Text:
Provider Credential Text:
MD
Provider Gender Code:
F

Provider's Other Name Information

Provider Other Organization Name:
Provider Other Organization Name Type Code:
Provider Other Last Name:
Provider Other First Name:
Provider Other Middle Name:
Provider Other Name Prefix Text:
Provider Other Name Suffix Text:
Provider Other Credential Text:
Provider Other Last Name Type Code:

NPI Number Information

NPI Number:
1508800954
Entity Type Code:
Individual
Replacement NPI:
Last Update Date:
03/07/2023
NPI Deactivation Reason Code:
NPI Deactivation Date:
NPI Reactivation Date:

Provider's Business Mailing Address

Provider First Line Business Mailing Address:
2756 POST RD
Provider Second Line Business Mailing Address:
#100
Provider Business Mailing Address City Name:
WARWICK
Provider Business Mailing Address State Name:
RI
Provider Business Mailing Address Postal Code:
02886-3003
Provider Business Mailing Address Country Code:
US
Provider Business Mailing Address Telephone Number:
401-738-4300
Provider Business Mailing Address Fax Number:
401-738-7718

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
50 HEALTH LN
Provider Second Line Business Practice Location Address:
Provider Business Practice Location Address City Name:
WARWICK
Provider Business Practice Location Address State Name:
RI
Provider Business Practice Location Address Postal Code:
02886-2711
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
401-738-4300
Provider Business Practice Location Address Fax Number:
401-738-7718
Provider Enumeration Date:
06/16/2006

Additional Information

Authorized Official

Authorized Official Last Name:
Authorized Official First Name:
Authorized Official Middle Name:
Authorized Official Title or Position:
Authorized Official Telephone Number:

Provider Taxonomy Codes

  • Taxonomy code: 174400000X , with the licence number:  MD9518 , registered in the state of RI ; information, associated with the NPI states the following Primary Taxonomy Switch: "N" .
  • Taxonomy code: 2084P0800X , with the licence number: MD09518 , registered in the state of RI ; information, associated with the NPI states the following Primary Taxonomy Switch: "Y" .

Other Provider's Identifiers (legacy, non-NPI)

  • Identifier: MD9518 . This is a "MD LICENSE" identifier , issued by the state of ( RI ) . This identifiers is of the category "OTHER".
  • Identifier: 7006353 , issued by the state of ( RI ) . This identifiers is of the category "MEDICAID".
  • Identifier: 15-05469 . This is a "UBH PROVIDER ID" identifier , issued by the state of ( RI ) . This identifiers is of the category "OTHER".
  • Identifier: 30113-6 . This is a "BLUE CROSS PROVIDER ID" identifier , issued by the state of ( RI ) . This identifiers is of the category "OTHER".
  • Identifier: 407215 . This is a "BLUE CHIP PROVIDER ID" identifier , issued by the state of ( RI ) . This identifiers is of the category "OTHER".




Copyright © 2007-2024 www.npivalidator.com