Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
Y | 207Q00000X | Family Doctor | 262673 | NY |
NPI | 1003196171 |
---|---|
Provider Name | Dr. Mara Cofler -Koldorff |
First Address | Islip Terrace, NY 11752-2716 |
Second Address | Islip Terrace, NY 11752-2716 |
Gender | F |
NPI Entity type | Individual |
Is Sole Proprietor | No |
Is Organization Subpart | N/A |
Enumeration Date | 22/08/2011 |
Last Update Date | 22/08/2011 |