Healthcare Provider Details

I. General information

NPI: 1164593257
Provider Name (Legal Business Name): MARK HOFFMAN MD
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 11/13/2006
Last Update Date: 07/08/2007
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

LIJMC-ONCOLOGY PAVILION 270-05 76TH AVENUE
NEW HYDE PARK NY
11040
US

IV. Provider business mailing address

LIJMC-ONCOLOGY PAVILION 270-05 76TH AVENUE
NEW HYDE PARK NY
11040
US

V. Phone/Fax

Practice location:
  • Phone: 718-470-8937
  • Fax:
Mailing address:
  • Phone: 718-470-8937
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code207RH0003X
TaxonomyHematology & Oncology Physician
License Number157058
License Number StateNY

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: