Healthcare Provider Details

I. General information

NPI: 1700406980
Provider Name (Legal Business Name): SAMUEL HOFFMAN
Entity Type: Individual
Gender: Male
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 04/17/2020
Last Update Date: 09/06/2024
Certification Date: 08/27/2024
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1000 MONTAUK HWY
WEST ISLIP NY
11795-4927
US

IV. Provider business mailing address

180 N JEFFERSON ST UNIT 1410
CHICAGO IL
60661-1463
US

V. Phone/Fax

Practice location:
  • Phone: 631-376-3000
  • Fax: 631-376-3420
Mailing address:
  • Phone: 516-574-3625
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code390200000X
TaxonomyStudent in an Organized Health Care Education/Training Program
License Number
License Number State
# 2
Primary TaxonomyY
Taxonomy Code207PE0004X
TaxonomyEmergency Medical Services (Emergency Medicine) Physician
License Number036169400
License Number StateIL

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: