Healthcare Provider Details

I. General information

NPI: 1104734045
Provider Name (Legal Business Name): GERHARD PETER HOPFENSITZ LMSW
Entity Type: Individual
Gender: Male
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 08/31/2026
Last Update Date: 08/31/2026
Certification Date: 08/31/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

87 BAY AVE
SOUTHAMPTON NY
11968-1924
US

IV. Provider business mailing address

87 BAY AVE
SOUTHAMPTON NY
11968-1924
US

V. Phone/Fax

Practice location:
  • Phone: 631-353-2279
  • Fax: 631-494-2272
Mailing address:
  • Phone: 631-353-2279
  • Fax: 631-494-2272

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code104100000X
TaxonomySocial Worker
License Number115145-01
License Number StateNY

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: