Healthcare Provider Details

I. General information

NPI: 1508143504
Provider Name (Legal Business Name): KATHY HOFFSTADTER-THAL NP
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 11/04/2011
Last Update Date: 11/04/2011
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1 GUSTAVE L LEVY PL
NEW YORK NY
10029-6500
US

IV. Provider business mailing address

1 GUSTAVE L. LEVY PLACE
NEW YORK NY
10029
US

V. Phone/Fax

Practice location:
  • Phone: 212-241-4859
  • Fax: 212-241-1597
Mailing address:
  • Phone: 212-241-4859
  • Fax: 212-241-1597

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code363LP0200X
TaxonomyPediatric Nurse Practitioner
License NumberF381301
License Number StateNY

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: