Provider Demographics
NPI:1114071750
Name:HOFFMAN, E. SHANE (MACOM, AC)
Entity Type:Individual
Prefix:
First Name:E.
Middle Name:SHANE
Last Name:HOFFMAN
Suffix:
Gender:M
Credentials:MACOM, AC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1841 BROADWAY RM 509
Mailing Address - Street 2:
Mailing Address - City:NEW YORK
Mailing Address - State:NY
Mailing Address - Zip Code:10023-7603
Mailing Address - Country:US
Mailing Address - Phone:212-489-5038
Mailing Address - Fax:
Practice Address - Street 1:1841 BROADWAY RM 509
Practice Address - Street 2:
Practice Address - City:NEW YORK
Practice Address - State:NY
Practice Address - Zip Code:10023-7603
Practice Address - Country:US
Practice Address - Phone:212-489-5038
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2007-01-22
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY001314171100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes171100000XOther Service ProvidersAcupuncturist