Healthcare Provider Details

I. General information

NPI: 1760639280
Provider Name (Legal Business Name): ELLEN BROSOFSKY HOFFER NP
Entity Type: Individual
Gender: Female
Sole Proprietor: N

Provider Other Name: ELLEN R BROSOFSKY NP

II. Dates (important events)

Enumeration Date: 08/27/2008
Last Update Date: 03/15/2022
Certification Date: 03/15/2022
Deactivation Date:
Reactivation Date:

III. Provider practice location address

455 TOLL GATE RD
WARWICK RI
02886-2759
US

IV. Provider business mailing address

455 TOLLGATE RD PROFESSIONAL REVENUE CYCLE & CREDENTIALING
WARWICK RI
02886-2759
US

V. Phone/Fax

Practice location:
  • Phone: 401-681-4996
  • Fax: 401-921-6569
Mailing address:
  • Phone: 401-273-0641
  • Fax: 401-273-2919

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code363LF0000X
TaxonomyFamily Nurse Practitioner
License NumberAPRN00217
License Number StateRI

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: