Healthcare Provider Details

I. General information

NPI: 1831190008
Provider Name (Legal Business Name): MICHAEL L HOFFMAN M.D.
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 08/09/2005
Last Update Date: 06/10/2020
Certification Date: 06/10/2020
Deactivation Date:
Reactivation Date:

III. Provider practice location address

560 NORTHERN BLVD SUITE 107
GREAT NECK NY
11021-5113
US

IV. Provider business mailing address

560 NORTHERN BLVD SUITE 107
GREAT NECK NY
11021-5113
US

V. Phone/Fax

Practice location:
  • Phone: 516-498-3500
  • Fax: 516-498-3517
Mailing address:
  • Phone: 516-498-3500
  • Fax: 516-498-3517

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code207RR0500X
TaxonomyRheumatology Physician
License Number096586
License Number StateNY

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: