Provider Demographics
NPI:1679550412
Name:HOFFMAN, LISA B (MD)
Entity Type:Individual
Prefix:
First Name:LISA
Middle Name:B
Last Name:HOFFMAN
Suffix:
Gender:F
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1026 UNION RD
Mailing Address - Street 2:
Mailing Address - City:WEST SENECA
Mailing Address - State:NY
Mailing Address - Zip Code:14224-3449
Mailing Address - Country:US
Mailing Address - Phone:716-712-0851
Mailing Address - Fax:716-712-0853
Practice Address - Street 1:1026 UNION RD
Practice Address - Street 2:
Practice Address - City:WEST SENECA
Practice Address - State:NY
Practice Address - Zip Code:14224-3449
Practice Address - Country:US
Practice Address - Phone:716-712-0851
Practice Address - Fax:716-712-0853
Is Sole Proprietor?:No
Enumeration Date:2005-12-22
Last Update Date:2014-07-20
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY190033207R00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207R00000XAllopathic & Osteopathic PhysiciansInternal Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
NY403378OtherWELLCARE
NY0409807OtherIHA
NY000524982003OtherBC/BS
NY040426035704OtherFIDELIS
NY00010077703OtherUNIVERA
NY01505206Medicaid
NY145823BJOtherPREFERRED CARE
NY01505206Medicaid
NY0409807OtherIHA
NY145823BJOtherPREFERRED CARE