Provider Demographics
NPI:1467790394
Name:HOFFMAN, MICHAEL (RPA)
Entity Type:Individual
Prefix:
First Name:MICHAEL
Middle Name:
Last Name:HOFFMAN
Suffix:
Gender:M
Credentials:RPA
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:515 BROADWAY
Mailing Address - Street 2:
Mailing Address - City:MASSAPEQUA
Mailing Address - State:NY
Mailing Address - Zip Code:11758-5005
Mailing Address - Country:US
Mailing Address - Phone:516-799-2700
Mailing Address - Fax:516-799-8023
Practice Address - Street 1:515 BROADWAY
Practice Address - Street 2:
Practice Address - City:MASSAPEQUA
Practice Address - State:NY
Practice Address - Zip Code:11758-5005
Practice Address - Country:US
Practice Address - Phone:516-799-2700
Practice Address - Fax:516-799-8023
Is Sole Proprietor?:No
Enumeration Date:2013-01-28
Last Update Date:2013-01-28
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY010563363A00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363A00000XPhysician Assistants & Advanced Practice Nursing ProvidersPhysician Assistant