Healthcare Provider Details

I. General information

NPI: 1205454634
Provider Name (Legal Business Name): HEIDI LEILANI HOFBAUER-BUZZY ATC
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 07/13/2020
Last Update Date: 07/13/2020
Certification Date: 07/13/2020
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1 HARTWICK DR
ONEONTA NY
13820-4000
US

IV. Provider business mailing address

PO BOX 4020
ONEONTA NY
13820-4020
US

V. Phone/Fax

Practice location:
  • Phone: 607-431-4694
  • Fax: 607-431-4085
Mailing address:
  • Phone: 607-431-4694
  • Fax: 607-431-4085

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code2255A2300X
TaxonomyAthletic Trainer
License Number000087
License Number StateNY

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: