Healthcare Provider Details

I. General information

NPI: 1801897491
Provider Name (Legal Business Name): CELSO A HOFILENA JR. M.D.
Entity Type: Individual
Gender: Male
Sole Proprietor: X

II. Dates (important events)

Enumeration Date: 08/03/2005
Last Update Date: 07/08/2007
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

5505 NESCONSET HWY
MT SINAI NY
11766-2037
US

IV. Provider business mailing address

1770 MOTOR PKWY
ISLANDIA NY
11749-5260
US

V. Phone/Fax

Practice location:
  • Phone: 631-434-1770
  • Fax: 631-234-6175
Mailing address:
  • Phone: 631-434-1770
  • Fax: 631-234-6175

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code208000000X
TaxonomyPediatrics Physician
License Number199883
License Number StateNY

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: