Healthcare Provider Details

I. General information

NPI: 1427369651
Provider Name (Legal Business Name): JESSE J HOFER JESSE HOFER
Entity Type: Individual
Gender: Male
Sole Proprietor: Y

Provider Other Name: JESSE HOFER JESSE HOFER

II. Dates (important events)

Enumeration Date: 06/22/2010
Last Update Date: 04/08/2016
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

2224 ROUTE 37 E SUITE 2
TOMS RIVER NJ
08753-6000
US

IV. Provider business mailing address

2224 ROUTE 37 E SUITE 2
TOMS RIVER NJ
08753-6000
US

V. Phone/Fax

Practice location:
  • Phone: 732-270-8300
  • Fax: 732-270-2781
Mailing address:
  • Phone: 732-270-8300
  • Fax: 732-270-2781

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code1223P0300X
TaxonomyPeriodontics
License Number22DI02437500
License Number StateNJ

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: