Healthcare Provider Details

I. General information

NPI: 1568735595
Provider Name (Legal Business Name): JENNIFER HOFSTEIN-MINIKES R.D.
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 02/22/2012
Last Update Date: 03/06/2012
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

622 W 168TH ST ROOM 517
NEW YORK NY
10032-3720
US

IV. Provider business mailing address

622 W 168TH ST ROOM 517
NEW YORK NY
10032-3720
US

V. Phone/Fax

Practice location:
  • Phone: 212-305-5717
  • Fax: 212-304-5699
Mailing address:
  • Phone: 212-305-5717
  • Fax: 212-304-5699

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code133V00000X
TaxonomyRegistered Dietitian
License Number005002
License Number StateNY

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: