Healthcare Provider Details

I. General information

NPI: 1720278500
Provider Name (Legal Business Name): JEREMY JAY HOFF D.O.
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 07/27/2007
Last Update Date: 06/11/2019
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

2716 ASHTON DR
WILMINGTON NC
28412
US

IV. Provider business mailing address

2716 ASHTON DR
WILMINGTON NC
28412-2489
US

V. Phone/Fax

Practice location:
  • Phone: 910-332-3800
  • Fax: 910-251-0421
Mailing address:
  • Phone: 910-332-3800
  • Fax: 910-251-0421

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code208100000X
TaxonomyPhysical Medicine & Rehabilitation Physician
License Number0102202405
License Number StateVA
# 2
Primary TaxonomyY
Taxonomy Code208100000X
TaxonomyPhysical Medicine & Rehabilitation Physician
License Number2018-01336
License Number StateNC
# 3
Primary TaxonomyN
Taxonomy Code208VP0014X
TaxonomyInterventional Pain Medicine Physician
License Number0102202405
License Number StateVA
# 4
Primary TaxonomyN
Taxonomy Code208VP0014X
TaxonomyInterventional Pain Medicine Physician
License Number2018-01336
License Number StateNC

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: