Healthcare Provider Details

I. General information

NPI: 1871585331
Provider Name (Legal Business Name): FRED HOFFMAN RPH
Entity Type: Individual
Gender: Male
Sole Proprietor: X

II. Dates (important events)

Enumeration Date: 08/19/2005
Last Update Date: 07/08/2007
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

19718 HILLSIDE AVE
HOLLIS NY
11423-2127
US

IV. Provider business mailing address

19718 HILLSIDE AVE
HOLLIS NY
11423-2127
US

V. Phone/Fax

Practice location:
  • Phone: 718-464-2400
  • Fax: 718-736-0600
Mailing address:
  • Phone: 718-464-2400
  • Fax: 718-736-0600

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code183500000X
TaxonomyPharmacist
License Number037860-1
License Number StateNY

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: