Provider Demographics
NPI:1376275644
Name:HOFFMAN, ELIZABETH (CNS)
Entity Type:Individual
Prefix:
First Name:ELIZABETH
Middle Name:
Last Name:HOFFMAN
Suffix:
Gender:F
Credentials:CNS
Other - Prefix:
Other - First Name:ELIZABETH
Other - Middle Name:HOFFMAN
Other - Last Name:JACKOWITZ
Other - Suffix:
Other - Last Name Type:Other Name
Other - Credentials:CNS
Mailing Address - Street 1:141 MAYWEED RD
Mailing Address - Street 2:
Mailing Address - City:FAIRFIELD
Mailing Address - State:CT
Mailing Address - Zip Code:06824-4524
Mailing Address - Country:US
Mailing Address - Phone:917-692-2539
Mailing Address - Fax:
Practice Address - Street 1:141 MAYWEED RD
Practice Address - Street 2:
Practice Address - City:FAIRFIELD
Practice Address - State:CT
Practice Address - Zip Code:06824-4524
Practice Address - Country:US
Practice Address - Phone:917-692-2539
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2022-06-27
Last Update Date:2022-06-27
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CT18419133N00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes133N00000XDietary & Nutritional Service ProvidersNutritionistGroup - Single Specialty