Healthcare Provider Details

I. General information

NPI: 1063434355
Provider Name (Legal Business Name): MS. BEVERLY HOFFMAN
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 07/24/2006
Last Update Date: 07/08/2007
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

333 E 49TH ST SUITE LOBBY A
NEW YORK NY
10017-1680
US

IV. Provider business mailing address

114 SOUNDVIEW TER
NORTHPORT NY
11768-1230
US

V. Phone/Fax

Practice location:
  • Phone: 212-751-8020
  • Fax: 631-754-7013
Mailing address:
  • Phone: 631-754-0094
  • Fax: 631-754-7013

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code1041C0700X
TaxonomyClinical Social Worker
License NumberR030128
License Number StateNY

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: