Healthcare Provider Details

I. General information

NPI: 1528358777
Provider Name (Legal Business Name): EDWARD LESLIE HOFFMAN PH.D.
Entity Type: Individual
Gender: Male
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 04/08/2011
Last Update Date: 04/08/2011
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

19 W 34TH ST
NEW YORK NY
10001-3006
US

IV. Provider business mailing address

19 W 34TH ST
NEW YORK NY
10001-3006
US

V. Phone/Fax

Practice location:
  • Phone: 212-947-7111
  • Fax: 212-239-0948
Mailing address:
  • Phone: 212-947-7111
  • Fax: 212-239-0948

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code103TC0700X
TaxonomyClinical Psychologist
License Number7773-1
License Number StateNY

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: