Richard Wallace Koffler CASAC

NPI 1154494102 - Counselor - 101YA0400X

NPI Details
NPI 1154494102
Gender Male
Enumeration Date 11/16/2006
Last Updated 07/08/2007
Entity Type Individual
Active Over 10 years ago
Practice Location
8268 164TH ST
JAMAICA NY, 11432-1121, US
Phone (718) 883-3225
Fax (718) 883-6193
Business Location
7901 BROADWAY
MANAGED CARE, D1-01
ELMHURST NY, 11373-1329, US
Phone (718) 334-1921
Fax (718) 334-3432
Toxanomy
Taxonomy Code 101YA0400X
License State New York
License Number 005475
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According to our database, Richard Wallace Koffler CASAC NPI is 1154494102, taxonomy code is 101YA0400X and license number is 005475, license state is located at New York. Richard Wallace Koffler CASAC physically located at 8268 164th St, Jamaica NY, 11432-1121. NPI Number Richard Wallace Koffler CASAC has the Individual type.

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1154494102 NPI number is provided on an as is basis without warranty of any kind. 1154494102 is maintained by the National Plan & Provider Enumeration System. The contents of Richard Wallace Koffler CASAC are for informational purposes only.