Healthcare Provider Details

I. General information

NPI: 1689121774
Provider Name (Legal Business Name): DANIEL RYAN HOFFMAN C.A.S.
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 09/06/2016
Last Update Date: 03/03/2017
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

53 MERCER ST
ALBANY NY
12203-3616
US

IV. Provider business mailing address

53 MERCER ST
ALBANY NY
12203-3616
US

V. Phone/Fax

Practice location:
  • Phone: 845-323-9639
  • Fax:
Mailing address:
  • Phone: 845-323-9639
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code103T00000X
TaxonomyPsychologist
License Number1074521161
License Number StateNY

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: