Healthcare Provider Details

I. General information

NPI: 1063548899
Provider Name (Legal Business Name): REGINALD ANTHONY HOFFLER M.D.
Entity Type: Individual
Gender: Male
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 02/26/2007
Last Update Date: 07/08/2007
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1106 NORTH AVE
BRIDGEPORT CT
06604-2710
US

IV. Provider business mailing address

PO BOX 1468
NEW HAVEN CT
06506-1468
US

V. Phone/Fax

Practice location:
  • Phone: 203-579-6131
  • Fax: 203-382-8464
Mailing address:
  • Phone: 203-387-0678
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code2084P0800X
TaxonomyPsychiatry Physician
License Number025989
License Number StateCT

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: