Provider Demographics
NPI:1487884516
Name:ELENA M KOFMAN DMD PC
Entity type:Organization
Organization Name:ELENA M KOFMAN DMD PC
Other - Org Name:<UNAVAIL>
Other - Org Type:
Authorized Official - Title/Position:OWNER/DENTIST
Authorized Official - Prefix:DR
Authorized Official - First Name:ELENA
Authorized Official - Middle Name:M
Authorized Official - Last Name:KOFMAN
Authorized Official - Suffix:
Authorized Official - Credentials:DMD
Authorized Official - Phone:610-692-1808
Mailing Address - Street 1:1599 PAOLI PIKE
Mailing Address - Street 2:
Mailing Address - City:WEST CHESTER
Mailing Address - State:PA
Mailing Address - Zip Code:19380-6113
Mailing Address - Country:US
Mailing Address - Phone:610-692-1808
Mailing Address - Fax:610-692-0509
Practice Address - Street 1:1599 PAOLI PIKE
Practice Address - Street 2:
Practice Address - City:WEST CHESTER
Practice Address - State:PA
Practice Address - Zip Code:19380-6113
Practice Address - Country:US
Practice Address - Phone:610-692-1808
Practice Address - Fax:610-692-0509
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2009-07-23
Last Update Date:2009-07-23
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
PADS0351761223G0001X
PADS0363301223P0300X
PADS29460L1223G0001X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes1223G0001XDental ProvidersDentistGeneral PracticeGroup - Multi-Specialty
No1223P0300XDental ProvidersDentistPeriodonticsGroup - Multi-Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
PA134197OtherUNITED CONCORDIA