Basic Information
| Provider Information | |||||||||
| NPI: | 1619979259 | ||||||||
| EntityType: | 1 | ||||||||
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| OrganizationName: | |||||||||
| LastName: | POFF | ||||||||
| FirstName: | JOHN | ||||||||
| MiddleName: | E | ||||||||
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| Credential: | MD | ||||||||
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| Mailing Information | |||||||||
| Address1: | 3725 81ST ST | ||||||||
| Address2: | APARTMENT 1E | ||||||||
| City: | JACKSON HEIGHTS | ||||||||
| State: | NY | ||||||||
| PostalCode: | 113726970 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 2123602600 | ||||||||
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| Practice Location | |||||||||
| Address1: | 212 E 106TH ST | ||||||||
| Address2: | SETTLEMENT HEALTH | ||||||||
| City: | NEW YORK | ||||||||
| State: | NY | ||||||||
| PostalCode: | 100294007 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 2123602600 | ||||||||
| FaxNumber: | 2123602618 | ||||||||
| Other Information | |||||||||
| ProviderEnumerationDate: | 08/12/2005 | ||||||||
| LastUpdateDate: | 04/23/2014 | ||||||||
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| ProviderGenderCode: | M | ||||||||
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| IsSoleProprietor: | N | ||||||||
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Taxonomy Information
| Taxonomy | License | State | Switch | TaxonomyGroup | TaxonomyType | TaxonomyClass | SubSpecialty | 207R00000X | 207633 | NY | Y | Allopathic & Osteopathic Physicians | Internal Medicine |
ID Information
| ID | Type | State | Issuer | Description | 00355151 | 05 | NY | MEDICAID |