Healthcare Provider Details

I. General information

NPI: 1013002559
Provider Name (Legal Business Name): IRA R HOFFMAN M.D.
Entity Type: Individual
Gender: Male
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 10/03/2006
Last Update Date: 10/02/2007
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

800A 5TH AVE SUITE #301
NEW YORK NY
10065-7215
US

IV. Provider business mailing address

800A 5TH AVE SUITE #301
NEW YORK NY
10065-7215
US

V. Phone/Fax

Practice location:
  • Phone: 212-755-7711
  • Fax: 212-688-2207
Mailing address:
  • Phone: 212-755-7711
  • Fax: 212-688-2207

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code170100000X
TaxonomyPh.D. Medical Genetics
License Number80118
License Number StateNY

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: