Healthcare Provider Details

I. General information

NPI: 1417391251
Provider Name (Legal Business Name): MICHAEL A HOFFNUNG D.O.
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 04/23/2013
Last Update Date: 07/23/2018
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1 SOUTH PROSPECT STREET ARNOLD LEVEL 3
BURLINGTON VT
05401
US

IV. Provider business mailing address

1 SOUTH PROSPECT STREET ARNOLD LEVEL 3
BURLINGTON VT
05401
US

V. Phone/Fax

Practice location:
  • Phone: 718-470-8765
  • Fax:
Mailing address:
  • Phone:
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code2084P0800X
TaxonomyPsychiatry Physician
License Number277397
License Number StateNY
# 2
Primary TaxonomyN
Taxonomy Code2084P0800X
TaxonomyPsychiatry Physician
License Number032.0133809
License Number StateVT
# 3
Primary TaxonomyN
Taxonomy Code2084P0804X
TaxonomyChild & Adolescent Psychiatry Physician
License Number277397
License Number StateNY
# 4
Primary TaxonomyY
Taxonomy Code2084P0804X
TaxonomyChild & Adolescent Psychiatry Physician
License Number032.0133809
License Number StateVT

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: