Provider Demographics
NPI:1356476063
Name:HOFFMAN, RUSSELL R
Entity Type:Individual
Prefix:
First Name:RUSSELL
Middle Name:R
Last Name:HOFFMAN
Suffix:
Gender:M
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:576 SPRINGFIELD AVE
Mailing Address - Street 2:
Mailing Address - City:SUMMIT
Mailing Address - State:NJ
Mailing Address - Zip Code:07901-4502
Mailing Address - Country:US
Mailing Address - Phone:908-273-3335
Mailing Address - Fax:908-273-4648
Practice Address - Street 1:200 SHEFFIELD ST STE 313
Practice Address - Street 2:
Practice Address - City:MOUNTAINSIDE
Practice Address - State:NJ
Practice Address - Zip Code:07092-2321
Practice Address - Country:US
Practice Address - Phone:908-273-3335
Practice Address - Fax:908-273-4648
Is Sole Proprietor?:No
Enumeration Date:2007-02-22
Last Update Date:2021-03-11
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NJMA59282207V00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207V00000XAllopathic & Osteopathic PhysiciansObstetrics & Gynecology
Provider Identifiers
StateIdentifier IDID TypeIssuer
NJF73221Medicare UPIN
NJF747743Medicare ID - Type Unspecified