Healthcare Provider Details

I. General information

NPI: 1861541161
Provider Name (Legal Business Name): MARK H HOFFMAN PT EDD
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 01/09/2007
Last Update Date: 09/20/2011
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

3929 MORLOT AVENUE
FAIR LAWN NJ
07410-4918
US

IV. Provider business mailing address

3929 MORLOT AVENUE
FAIR LAWN NJ
07410-4918
US

V. Phone/Fax

Practice location:
  • Phone: 201-475-4003
  • Fax: 201-475-4002
Mailing address:
  • Phone: 201-475-4003
  • Fax: 201-475-4002

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code225100000X
TaxonomyPhysical Therapist
License NumberNJ40QA00109500
License Number StateNJ

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: