Healthcare Provider Details

I. General information

NPI: 1184471617
Provider Name (Legal Business Name): SETH HOFFMAN LMSW
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 05/02/2024
Last Update Date: 05/02/2024
Certification Date: 05/02/2024
Deactivation Date:
Reactivation Date:

III. Provider practice location address

9609 66TH AVE APT 6B
REGO PARK NY
11374-4114
US

IV. Provider business mailing address

9609 66TH AVE APT 6B
REGO PARK NY
11374-4114
US

V. Phone/Fax

Practice location:
  • Phone: 929-225-6179
  • Fax:
Mailing address:
  • Phone:
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code104100000X
TaxonomySocial Worker
License Number118407
License Number StateNY

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: