Healthcare Provider Details

I. General information

NPI: 1720171820
Provider Name (Legal Business Name): ERIC HOFFMANN M.D.
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 10/02/2006
Last Update Date: 07/11/2022
Certification Date: 07/11/2022
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: 631-744-3303
  • Fax: 631-744-1627
Mailing address:
  • Phone: 631-744-3303
  • 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

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: