Healthcare Provider Details

I. General information

NPI: 1326205576
Provider Name (Legal Business Name): CARL M HOFFMAN MD
Entity Type: Individual
Gender: Male
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 05/16/2008
Last Update Date: 05/16/2008
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

124 E 177TH ST #2F
BRONX NY
10453-5914
US

IV. Provider business mailing address

124 E 177TH ST #2F
BRONX NY
10453-5914
US

V. Phone/Fax

Practice location:
  • Phone: 212-576-7064
  • Fax:
Mailing address:
  • Phone: 212-576-7064
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code207Q00000X
TaxonomyFamily Medicine Physician
License NumberNY102700
License Number StateNY

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: