Healthcare Provider Details

I. General information

NPI: 1427631399
Provider Name (Legal Business Name): ANTONY HOFFMANN RD, CDN
Entity Type: Individual
Gender: Male
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 04/29/2021
Last Update Date: 04/29/2021
Certification Date: 04/29/2021
Deactivation Date:
Reactivation Date:

III. Provider practice location address

451 CLARKSON AVE
BROOKLYN NY
11203-2097
US

IV. Provider business mailing address

3335 81ST ST APT 3C
JACKSON HEIGHTS NY
11372-1334
US

V. Phone/Fax

Practice location:
  • Phone: 718-245-4475
  • Fax:
Mailing address:
  • Phone: 347-972-8919
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code133V00000X
TaxonomyRegistered Dietitian
License Number86002900
License Number StateNY

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: