Provider Demographics
NPI:1053485292
Name:HOFFMAN, KENNETH ROBERT (DAC, LAC)
Entity Type:Individual
Prefix:
First Name:KENNETH
Middle Name:ROBERT
Last Name:HOFFMAN
Suffix:
Gender:M
Credentials:DAC, LAC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:31 OLD ROUTE 7
Mailing Address - Street 2:
Mailing Address - City:BROOKFIELD
Mailing Address - State:CT
Mailing Address - Zip Code:06804-2041
Mailing Address - Country:US
Mailing Address - Phone:203-740-9300
Mailing Address - Fax:203-740-9301
Practice Address - Street 1:31 OLD ROUTE 7
Practice Address - Street 2:
Practice Address - City:BROOKFIELD
Practice Address - State:CT
Practice Address - Zip Code:06804-2041
Practice Address - Country:US
Practice Address - Phone:203-740-9300
Practice Address - Fax:203-740-9301
Is Sole Proprietor?:No
Enumeration Date:2006-11-20
Last Update Date:2015-04-09
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CT000314171100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes171100000XOther Service ProvidersAcupuncturist
Provider Identifiers
StateIdentifier IDID TypeIssuer
CT314OtherAETNA
CTP3464595OtherOXFORD PROVIDER NUMBER
CT940000314CT01OtherANTHEM PROVIDER NUMBER