Provider Demographics
NPI:1609894146
Name:DR BARRY HOFFMAN DO PA
Entity Type:Organization
Organization Name:DR BARRY HOFFMAN DO PA
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:INDIVIDUAL CORPORATION PRESIDENT
Authorized Official - Prefix:DR
Authorized Official - First Name:BARRY
Authorized Official - Middle Name:
Authorized Official - Last Name:HOFFMAN
Authorized Official - Suffix:
Authorized Official - Credentials:DO PA
Authorized Official - Phone:856-784-3313
Mailing Address - Street 1:ONE WHITE HOUSE PIKE
Mailing Address - Street 2:
Mailing Address - City:LINDENWOLD
Mailing Address - State:NJ
Mailing Address - Zip Code:08021-2344
Mailing Address - Country:US
Mailing Address - Phone:856-784-3313
Mailing Address - Fax:856-784-4770
Practice Address - Street 1:ONE WHITE HOUSE PIKE
Practice Address - Street 2:
Practice Address - City:LINDENWOLD
Practice Address - State:NJ
Practice Address - Zip Code:08021
Practice Address - Country:US
Practice Address - Phone:856-784-3313
Practice Address - Fax:856-784-4770
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-07-17
Last Update Date:2020-08-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NJ25MB02392700207Q00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes207Q00000XAllopathic & Osteopathic PhysiciansFamily MedicineGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
NJ2898608Medicaid
NJ2898608Medicaid