Provider Demographics
NPI:1063779510
Name:KOFMAN, ASHER MEYER
Entity type:Individual
Prefix:
First Name:ASHER
Middle Name:MEYER
Last Name:KOFMAN
Suffix:
Gender:M
Credentials:
Other - Prefix:
Other - First Name:ALEKSANDR
Other - Middle Name:
Other - Last Name:KOFMAN
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:
Mailing Address - Street 1:PO BOX 190886
Mailing Address - Street 2:
Mailing Address - City:BROOKLYN
Mailing Address - State:NY
Mailing Address - Zip Code:11219-0886
Mailing Address - Country:US
Mailing Address - Phone:718-753-5740
Mailing Address - Fax:
Practice Address - Street 1:760 BROADWAY
Practice Address - Street 2:
Practice Address - City:BROOKLYN
Practice Address - State:NY
Practice Address - Zip Code:11206-5317
Practice Address - Country:US
Practice Address - Phone:718-963-8000
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2012-04-20
Last Update Date:2012-04-20
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY046192183500000X
NJ28RI02603600183500000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes183500000XPharmacy Service ProvidersPharmacist