Provider Demographics
NPI:1639431869
Name:HOFSTRA, TIMOTHY JAMES (MD)
Entity Type:Individual
Prefix:
First Name:TIMOTHY
Middle Name:JAMES
Last Name:HOFSTRA
Suffix:
Gender:M
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:PO BOX 980615
Mailing Address - Street 2:RAD: DIAGNOSTIC
Mailing Address - City:RICHMOND
Mailing Address - State:VA
Mailing Address - Zip Code:23298-0615
Mailing Address - Country:US
Mailing Address - Phone:804-828-3524
Mailing Address - Fax:
Practice Address - Street 1:483 CRANBURY RD
Practice Address - Street 2:
Practice Address - City:EAST BRUNSWICK
Practice Address - State:NJ
Practice Address - Zip Code:08816-3610
Practice Address - Country:US
Practice Address - Phone:732-390-0040
Practice Address - Fax:732-955-8874
Is Sole Proprietor?:No
Enumeration Date:2012-06-13
Last Update Date:2024-04-19
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NJ25MA108573002085R0202X
VA390200000X
VA01012585702085R0202X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes2085R0202XAllopathic & Osteopathic PhysiciansRadiologyDiagnostic Radiology
No390200000XStudent, Health CareStudent in an Organized Health Care Education/Training Program