Basic Information
| Provider Information | |||||||||
| NPI: | 1508800954 | ||||||||
| EntityType: | 1 | ||||||||
| ReplacementNPI: | |||||||||
| OrganizationName: | |||||||||
| LastName: | KOYFMAN | ||||||||
| FirstName: | LILIYA | ||||||||
| MiddleName: | |||||||||
| NamePrefix: | DR. | ||||||||
| NameSuffix: | |||||||||
| Credential: | MD | ||||||||
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| Mailing Information | |||||||||
| Address1: | 2756 POST RD | ||||||||
| Address2: | #100 | ||||||||
| City: | WARWICK | ||||||||
| State: | RI | ||||||||
| PostalCode: | 028863003 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 4017384300 | ||||||||
| FaxNumber: | 4017387718 | ||||||||
| Practice Location | |||||||||
| Address1: | 50 HEALTH LN | ||||||||
| Address2: | |||||||||
| City: | WARWICK | ||||||||
| State: | RI | ||||||||
| PostalCode: | 028862711 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 4017384300 | ||||||||
| FaxNumber: | 4017387718 | ||||||||
| Other Information | |||||||||
| ProviderEnumerationDate: | 06/16/2006 | ||||||||
| LastUpdateDate: | 02/16/2017 | ||||||||
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| ProviderGenderCode: | F | ||||||||
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| IsSoleProprietor: | N | ||||||||
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Taxonomy Information
| Taxonomy | License | State | Switch | TaxonomyGroup | TaxonomyType | TaxonomyClass | SubSpecialty | 174400000X | MD9518 | RI | N | Other Service Providers | Specialist | 2084P0800X | MD09518 | RI | Y | Allopathic & Osteopathic Physicians | Psychiatry & Neurology | Psychiatry |
ID Information
| ID | Type | State | Issuer | Description | MD9518 | 01 | RI | MD LICENSE | OTHER | 7006353 | 05 | RI | MEDICAID | 15-05469 | 01 | RI | UBH PROVIDER ID | OTHER | BK5631242 | 01 | RI | DEA REGISTRATION | OTHER | 30113-6 | 01 | RI | BLUE CROSS PROVIDER ID | OTHER | 407215 | 01 | RI | BLUE CHIP PROVIDER ID | OTHER |