Healthcare Provider Details

I. General information

NPI: 1225308778
Provider Name (Legal Business Name): BERNARD HOFFMAN M.D. P.C.
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 12/30/2011
Last Update Date: 02/07/2012
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

12 FAULKNER LN
DIX HILLS NY
11746-5906
US

IV. Provider business mailing address

12 FAULKNER LN
DIX HILLS NY
11746-5906
US

V. Phone/Fax

Practice location:
  • Phone: 631-549-1567
  • Fax: 631-549-1567
Mailing address:
  • Phone: 631-549-1567
  • Fax: 631-549-1567

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code261QM0850X
TaxonomyAdult Mental Health Clinic/Center
License Number104064
License Number StateNY
# 2
Primary TaxonomyN
Taxonomy Code261QM0855X
TaxonomyAdolescent and Children Mental Health Clinic/Center
License Number104064
License Number StateNY

VIII. Authorized Official

Name: DR. BERNARD HOFFMAN
Title or Position: PRESIDENT
Credential: M.D.
Phone: 631-549-1567