Healthcare Provider Details

I. General information

NPI: 1861806267
Provider Name (Legal Business Name): MICHAEL HOFFNER
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 06/13/2014
Last Update Date: 07/16/2021
Certification Date: 07/16/2021
Deactivation Date:
Reactivation Date:

III. Provider practice location address

4515 NESCONSET HWY
PORT JEFFERSON STATION NY
11776-2600
US

IV. Provider business mailing address

4515 NESCONSET HWY
PORT JEFFERSON STATION NY
11776-2600
US

V. Phone/Fax

Practice location:
  • Phone: 631-240-3471
  • Fax:
Mailing address:
  • Phone: 631-240-3471
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code1041C0700X
TaxonomyClinical Social Worker
License Number089858
License Number StateNY

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: