Healthcare Provider Details

I. General information

NPI: 1508189804
Provider Name (Legal Business Name): DEENA KATHLEEN HOFFMAN PA-C
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 03/01/2010
Last Update Date: 03/01/2010
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

416 2ND ST APT 4L
BROOKLYN NY
11215-2412
US

IV. Provider business mailing address

416 2ND ST APT 4L
BROOKLYN NY
11215-2412
US

V. Phone/Fax

Practice location:
  • Phone: 347-277-2217
  • Fax:
Mailing address:
  • Phone: 347-277-2217
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code363A00000X
TaxonomyPhysician Assistant
License Number013865-1
License Number StateNY

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: