=====================================================
General NPI Number Information
=====================================================
NPI Number | 1659634293
-----------------------------------------------------
Entity Type | Organization
-----------------------------------------------------
Legal Business Name | SOPHIA NATURAL HEALTH CENTER
-----------------------------------------------------
=====================================================
Dates
=====================================================
Enumeration Date | 06/19/2012
-----------------------------------------------------
Last Update Date | 08/17/2015
-----------------------------------------------------
=====================================================
Provider Practice Location Address
=====================================================
Address Line | 31 OLD ROUTE 7
-----------------------------------------------------
City | BROOKFIELD
-----------------------------------------------------
State | CT
-----------------------------------------------------
Zip | 06804-1711
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 203-740-9300
-----------------------------------------------------
Fax | 203-740-9301
-----------------------------------------------------
=====================================================
Provider Business Mailing Address
=====================================================
Address Line | 31 OLD ROUTE 7
-----------------------------------------------------
City | BROOKFIELD
-----------------------------------------------------
State | CT
-----------------------------------------------------
Zip | 06804-1711
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 203-740-9300
-----------------------------------------------------
Fax | 203-740-9301
-----------------------------------------------------
=====================================================
Authorized Official
=====================================================
Title or Position | MEDICAL DIRECTOR
-----------------------------------------------------
Name | MR. KENNETH ROBERT HOFFMAN
-----------------------------------------------------
Credential | L.AC.
-----------------------------------------------------
Telephone | 203-740-9300
-----------------------------------------------------
=====================================================
Scope of Practice (Provider's specialty)
=====================================================
Taxonomy #1
-----------------------------------------------------
Taxonomy Code | 171100000X
-----------------------------------------------------
Taxonomy Name | Acupuncturist
-----------------------------------------------------
License Number | 000591
-----------------------------------------------------
License Number State | CT
-----------------------------------------------------
Taxonomy #2
-----------------------------------------------------
Taxonomy Code | 175F00000X
-----------------------------------------------------
Taxonomy Name | Naturopath
-----------------------------------------------------
License Number | 000498
-----------------------------------------------------
License Number State | CT
-----------------------------------------------------
Taxonomy #3
-----------------------------------------------------
Taxonomy Code | 171100000X
-----------------------------------------------------
Taxonomy Name | Acupuncturist
-----------------------------------------------------
License Number | 314
-----------------------------------------------------
License Number State | CT
-----------------------------------------------------