Healthcare Provider Details

I. General information

NPI: 1679550412
Provider Name (Legal Business Name): LISA B HOFFMAN M.D.
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 12/22/2005
Last Update Date: 07/20/2014
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1026 UNION RD
WEST SENECA NY
14224-3449
US

IV. Provider business mailing address

1026 UNION RD
WEST SENECA NY
14224-3449
US

V. Phone/Fax

Practice location:
  • Phone: 716-712-0851
  • Fax: 716-712-0853
Mailing address:
  • Phone: 716-712-0851
  • Fax: 716-712-0853

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code207R00000X
TaxonomyInternal Medicine Physician
License Number190033
License Number StateNY

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: