Healthcare Provider Details

I. General information

NPI: 1417047473
Provider Name (Legal Business Name): KEITH HOFFMAN
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 10/13/2006
Last Update Date: 07/08/2007
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

115 LIBERTY ST
BATH NY
14810-1508
US

IV. Provider business mailing address

6 WIGHTMAN AVE
HORNELL NY
14843-1119
US

V. Phone/Fax

Practice location:
  • Phone: 607-776-6577
  • Fax:
Mailing address:
  • Phone:
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code101YA0400X
TaxonomyAddiction (Substance Use Disorder) Counselor
License Number
License Number State

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: