Healthcare Provider Details

I. General information

NPI: 1487615670
Provider Name (Legal Business Name): LEONARD R. HOFFMAN D.D.S
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 03/29/2006
Last Update Date: 01/14/2008
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

134 MINEOLA BLVD 3RD FLOOR
MINEOLA NY
11501-3959
US

IV. Provider business mailing address

134 MINEOLA BLVD 3RD FLOOR
MINEOLA NY
11501-3959
US

V. Phone/Fax

Practice location:
  • Phone: 516-294-9696
  • Fax: 516-294-3531
Mailing address:
  • Phone: 516-294-9696
  • Fax: 516-294-3531

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code1223S0112X
TaxonomyOral and Maxillofacial Surgery (Dentist)
License Number027556
License Number StateNY

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: