Healthcare Provider Details

I. General information

NPI: 1558868893
Provider Name (Legal Business Name): NEIL HOFFMAN ATC
Entity Type: Individual
Gender: Male
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 04/12/2018
Last Update Date: 04/12/2018
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

5600 CITY AVE
PHILADELPHIA PA
19131-1395
US

IV. Provider business mailing address

327 NATURE DR
CHERRY HILL NJ
08003-3525
US

V. Phone/Fax

Practice location:
  • Phone: 610-660-1701
  • Fax:
Mailing address:
  • Phone: 215-300-1188
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code2255A2300X
TaxonomyAthletic Trainer
License NumberRTO000088
License Number StatePA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: