Healthcare Provider Details

I. General information

NPI: 1457608168
Provider Name (Legal Business Name): ANGELA ROSE HOFMAN L.AC L.M.T
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 08/13/2012
Last Update Date: 06/22/2023
Certification Date: 06/22/2023
Deactivation Date:
Reactivation Date:

III. Provider practice location address

107 NORTHERN BLVD SUITE 307
GREAT NECK NY
11021-4311
US

IV. Provider business mailing address

107 NORTHERN BLVD SUITE 307
GREAT NECK NY
11021-4311
US

V. Phone/Fax

Practice location:
  • Phone: 516-375-5305
  • Fax:
Mailing address:
  • Phone: 516-375-5305
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code225700000X
TaxonomyMassage Therapist
License Number019629-1
License Number StateNY
# 2
Primary TaxonomyN
Taxonomy Code225700000X
TaxonomyMassage Therapist
License Number98745
License Number StateFL
# 3
Primary TaxonomyY
Taxonomy Code171100000X
TaxonomyAcupuncturist
License Number004307-1
License Number StateNY
# 4
Primary TaxonomyN
Taxonomy Code171100000X
TaxonomyAcupuncturist
License Number4477
License Number StateFL

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: