1114067501 NPI number — DR. SERGEY KOYFMAN D. O.

Table of content: DR. SERGEY KOYFMAN D. O. (NPI 1114067501)

General

This information contains only most important part of the NPI data, for complete information, including NPI referencing materials please refer to 1114067501 NPI number — DR. SERGEY KOYFMAN D. O.

Organization/Personal Information

Employer Identification Number (EIN):
Provider Organization Name:
Provider Last Name:
KOYFMAN
Provider First Name:
SERGEY
Provider Middle Name:
Provider Name Prefix Text:
DR.
Provider Name Suffix Text:
Provider Credential Text:
D. O.
Provider Gender Code:
M

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:
1114067501
Entity Type Code:
Individual
Replacement NPI:
Last Update Date:
03/12/2025
NPI Deactivation Reason Code:
NPI Deactivation Date:
NPI Reactivation Date:

Provider's Business Mailing Address

Provider First Line Business Mailing Address:
660 WHITE PLAINS RD FL 4
Provider Second Line Business Mailing Address:
Provider Business Mailing Address City Name:
TARRYTOWN
Provider Business Mailing Address State Name:
NY
Provider Business Mailing Address Postal Code:
10591-5139
Provider Business Mailing Address Country Code:
US
Provider Business Mailing Address Telephone Number:
914-984-2546
Provider Business Mailing Address Fax Number:

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
75 CRYSTAL RUN RD
Provider Second Line Business Practice Location Address:
BUILDING B, SUITE 220
Provider Business Practice Location Address City Name:
MIDDLETOWN
Provider Business Practice Location Address State Name:
NY
Provider Business Practice Location Address Postal Code:
10941-7000
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
845-467-6998
Provider Business Practice Location Address Fax Number:
845-692-0675
Provider Enumeration Date:
02/07/2007

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: 207Y00000X , with the licence number:  244144 , registered in the state of NY ; information, associated with the NPI states the following Primary Taxonomy Switch: "Y" .

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

  • Identifier: WEA041 . This is a "MEDICARE - GROUP NUMBER" identifier , issued by the state of ( NY ) . This identifiers is of the category "OTHER".
  • Identifier: 97F18EA041 . This is a "MEDICARE INDIVIDUAL" identifier , issued by the state of ( NY ) . This identifiers is of the category "OTHER".




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