Healthcare Provider Details

I. General information

NPI: 1497715007
Provider Name (Legal Business Name): WENDY HOFFMAN MNT
Entity Type: Individual
Gender: Female
Sole Proprietor: X

II. Dates (important events)

Enumeration Date: 03/27/2006
Last Update Date: 07/08/2007
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

3003 NEW HYDE PARK RD 201
NEW HYDE PARK NY
11042-1214
US

IV. Provider business mailing address

3003 NEW HYDE PARK RD 201
NEW HYDE PARK NY
11042-1214
US

V. Phone/Fax

Practice location:
  • Phone: 516-327-0850
  • Fax: 516-327-0920
Mailing address:
  • Phone: 516-327-0850
  • Fax: 516-327-0920

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code133V00000X
TaxonomyRegistered Dietitian
License Number004753-1
License Number StateNY

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: