Healthcare Provider Details

I. General information

NPI: 1114071750
Provider Name (Legal Business Name): E. SHANE HOFFMAN MACOM, AC
Entity Type: Individual
Gender: Male
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 01/22/2007
Last Update Date: 07/08/2007
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1841 BROADWAY RM 509
NEW YORK NY
10023-7603
US

IV. Provider business mailing address

1841 BROADWAY RM 509
NEW YORK NY
10023-7603
US

V. Phone/Fax

Practice location:
  • Phone: 212-489-5038
  • Fax:
Mailing address:
  • Phone: 212-489-5038
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code171100000X
TaxonomyAcupuncturist
License Number001314
License Number StateNY

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: