Provider Demographics
NPI:1407014525
Name:VONHOFFEN, LORE ANNE (RPAC)
Entity Type:Individual
Prefix:MS
First Name:LORE
Middle Name:ANNE
Last Name:VONHOFFEN
Suffix:
Gender:F
Credentials:RPAC
Other - Prefix:MS
Other - First Name:LORE
Other - Middle Name:ANNE
Other - Last Name:VON HOFFEN
Other - Suffix:
Other - Last Name Type:Other Name
Other - Credentials:PHYSICIAN ASSISTANT
Mailing Address - Street 1:35 KETCHUM CT
Mailing Address - Street 2:
Mailing Address - City:EAST NORTHPORT
Mailing Address - State:NY
Mailing Address - Zip Code:11731-2000
Mailing Address - Country:US
Mailing Address - Phone:631-757-1197
Mailing Address - Fax:
Practice Address - Street 1:259 1ST ST
Practice Address - Street 2:
Practice Address - City:MINEOLA
Practice Address - State:NY
Practice Address - Zip Code:11501-3957
Practice Address - Country:US
Practice Address - Phone:516-663-8700
Practice Address - Fax:516-663-8707
Is Sole Proprietor?:Yes
Enumeration Date:2008-05-27
Last Update Date:2017-03-09
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY0036721363AS0400X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363AS0400XPhysician Assistants & Advanced Practice Nursing ProvidersPhysician AssistantSurgical