Healthcare Provider Details

I. General information

NPI: 1164691879
Provider Name (Legal Business Name): SHOREHAM MEDICAL SERVICES P.C.
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 02/27/2008
Last Update Date: 02/29/2008
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

45 ROUTE 25A SUITE C
SHOREHAM NY
11786-1389
US

IV. Provider business mailing address

45 ROUTE 25A SUITE C
SHOREHAM NY
11786-1389
US

V. Phone/Fax

Practice location:
  • Phone: 631-849-6116
  • Fax: 631-744-1627
Mailing address:
  • Phone: 631-849-6116
  • Fax: 631-744-1627

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code207R00000X
TaxonomyInternal Medicine Physician
License Number153867
License Number StateNY
# 2
Primary TaxonomyN
Taxonomy Code207RC0000X
TaxonomyCardiovascular Disease Physician
License Number146883
License Number StateNY

VIII. Authorized Official

Name: DR. ERIC HOFFMANN
Title or Position: CEO
Credential: M.D.
Phone: 631-849-6116