Healthcare Provider Details

I. General information

NPI: 1356476063
Provider Name (Legal Business Name): RUSSELL R HOFFMAN
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 02/22/2007
Last Update Date: 03/11/2021
Certification Date: 03/11/2021
Deactivation Date:
Reactivation Date:

III. Provider practice location address

200 SHEFFIELD ST STE 313
MOUNTAINSIDE NJ
07092-2321
US

IV. Provider business mailing address

576 SPRINGFIELD AVE
SUMMIT NJ
07901-4502
US

V. Phone/Fax

Practice location:
  • Phone: 908-273-3335
  • Fax: 908-273-4648
Mailing address:
  • Phone: 908-273-3335
  • Fax: 908-273-4648

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code207V00000X
TaxonomyObstetrics & Gynecology Physician
License NumberMA59282
License Number StateNJ

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: