Healthcare Provider Details

I. General information

NPI: 1639778293
Provider Name (Legal Business Name): KILE HOFFMAN HIS
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 10/23/2020
Last Update Date: 10/23/2020
Certification Date: 10/21/2020
Deactivation Date:
Reactivation Date:

III. Provider practice location address

3100 QUAKERBRIDGE RD
HAMILTON NJ
08619-1658
US

IV. Provider business mailing address

329 MARLTON PIKE WEST MIRACLE-EAR CENTER
CHERRY HILL NJ
08002
US

V. Phone/Fax

Practice location:
  • Phone: 609-249-4257
  • Fax: 856-665-6813
Mailing address:
  • Phone: 856-471-7870
  • Fax: 856-665-6813

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code237700000X
TaxonomyHearing Instrument Specialist
License Number25MG00148500
License Number StateNJ

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: