Provider Demographics
NPI:1083259485
Name:HOFFMAN, RUSSELL (PSYD)
Entity Type:Individual
Prefix:DR
First Name:RUSSELL
Middle Name:
Last Name:HOFFMAN
Suffix:
Gender:M
Credentials:PSYD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:3600 FIELDSTON RD APT 2K
Mailing Address - Street 2:
Mailing Address - City:BRONX
Mailing Address - State:NY
Mailing Address - Zip Code:10463-2007
Mailing Address - Country:US
Mailing Address - Phone:917-533-4601
Mailing Address - Fax:
Practice Address - Street 1:3600 FIELDSTON RD APT 2K
Practice Address - Street 2:
Practice Address - City:BRONX
Practice Address - State:NY
Practice Address - Zip Code:10463-2007
Practice Address - Country:US
Practice Address - Phone:917-533-4601
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2019-11-10
Last Update Date:2019-11-10
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY014874-1103TC2200X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes103TC2200XBehavioral Health & Social Service ProvidersPsychologistClinical Child & Adolescent