Healthcare Provider Details

I. General information

NPI: 1114404761
Provider Name (Legal Business Name): GABRIEL HOFFNUNG PHD
Entity Type: Individual
Gender: Male
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 07/26/2018
Last Update Date: 07/26/2018
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

483 HAROLD ST
STATEN ISLAND NY
10314-5017
US

IV. Provider business mailing address

81 BIRCHARD AVE
STATEN ISLAND NY
10314-4138
US

V. Phone/Fax

Practice location:
  • Phone: 845-304-2066
  • Fax:
Mailing address:
  • Phone: 845-304-2066
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code103T00000X
TaxonomyPsychologist
License Number
License Number State

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: