Healthcare Provider Details

I. General information

NPI: 1568864999
Provider Name (Legal Business Name): MARINA HOFFMAN
Entity Type: Individual
Gender: Female
Sole Proprietor: N

Provider Other Name: MARINA FRIDKIN APRN

II. Dates (important events)

Enumeration Date: 09/17/2014
Last Update Date: 02/22/2018
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

100 GRAND ST
NEW BRITAIN CT
06052-2016
US

IV. Provider business mailing address

102 LOFGREN RD
AVON CT
06001-3170
US

V. Phone/Fax

Practice location:
  • Phone: 860-224-5694
  • Fax: 860-224-5749
Mailing address:
  • Phone: 860-716-7998
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code207RC0000X
TaxonomyCardiovascular Disease Physician
License Number7174
License Number StateCT

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: