Provider Demographics
NPI:1699351957
Name:IMHOF, JOHN E
Entity Type:Individual
Prefix:
First Name:JOHN
Middle Name:E
Last Name:IMHOF
Suffix:
Gender:M
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:54 S NASSAU ST
Mailing Address - Street 2:
Mailing Address - City:BETHPAGE
Mailing Address - State:NY
Mailing Address - Zip Code:11714-4333
Mailing Address - Country:US
Mailing Address - Phone:516-443-2110
Mailing Address - Fax:
Practice Address - Street 1:70 GLEN COVE RD STE 207
Practice Address - Street 2:
Practice Address - City:ROSLYN HEIGHTS
Practice Address - State:NY
Practice Address - Zip Code:11577-1730
Practice Address - Country:US
Practice Address - Phone:516-443-2110
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2021-03-18
Last Update Date:2021-03-18
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY0246701041C0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1041C0700XBehavioral Health & Social Service ProvidersSocial WorkerClinical