Healthcare Provider Details

I. General information

NPI: 1376275644
Provider Name (Legal Business Name): ELIZABETH HOFFMAN CNS
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

Provider Other Name: ELIZABETH HOFFMAN JACKOWITZ CNS

II. Dates (important events)

Enumeration Date: 06/27/2022
Last Update Date: 06/27/2022
Certification Date: 06/27/2022
Deactivation Date:
Reactivation Date:

III. Provider practice location address

141 MAYWEED RD
FAIRFIELD CT
06824-4524
US

IV. Provider business mailing address

141 MAYWEED RD
FAIRFIELD CT
06824-4524
US

V. Phone/Fax

Practice location:
  • Phone: 917-692-2539
  • Fax:
Mailing address:
  • Phone: 917-692-2539
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code133N00000X
TaxonomyNutritionist
License Number18419
License Number StateCT

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: