MEDICARE: MR. RAY STEPHAN HOFFMAN L. AC.

Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

#	Taxonomy Code	Taxonomy	License Number	License Number State
1	171100000X	Acupuncturist	02848	NY
2	171100000X	Acupuncturist	25MZ00057800	NJ

General Provider Information

NPI Number	:	1205907482
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	MR. RAY STEPHAN HOFFMAN L. AC.

Provider Business Mailing Address
First Line	:	174 VALLEY RD
Second Line	:
City	:	MONTCLAIR
State	:	NJ
Zip	:	07042-2323
Country	:	US
Telephone Number	:	917-655-1509
Fax Number	:

Provider Business Practice Location Address
First Line	:	70 PARK ST
Second Line	:	#101
City	:	MONTCLAIR
State	:	NJ
Zip	:	07042-5907
Country	:	US
Telephone Number	:	973-744-8771
Fax Number	:	973-744-8773

Authorized Official
Title or Position	:
Name	:
Credential	:
Telephone Number	:

Provider Enumeration Date	:	11/10/2006
Last Update Date	:	09/30/2013

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