Healthcare Provider Details

I. General information

NPI: 1740261510
Provider Name (Legal Business Name): DOUGLAS M HOFFMAN MD
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 11/09/2005
Last Update Date: 09/18/2012
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

2315 BROADWAY WEILL CORNELL MEDICAL ASSOCIATES
NEW YORK NY
10024-4332
US

IV. Provider business mailing address

575 LEXINGTON AVE SUITE 540
NEW YORK NY
10022-6102
US

V. Phone/Fax

Practice location:
  • Phone: 646-962-2110
  • Fax:
Mailing address:
  • Phone: 646-962-2110
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code208000000X
TaxonomyPediatrics Physician
License Number159589
License Number StateMA
# 2
Primary TaxonomyN
Taxonomy Code208000000X
TaxonomyPediatrics Physician
License Number265617
License Number StateNY

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: