Provider Demographics
NPI:1891718763
Name:HOFFMAN, HERBERT SAUL (MD)
Entity Type:Individual
Prefix:
First Name:HERBERT
Middle Name:SAUL
Last Name:HOFFMAN
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 1:1170 NEW BRITAIN AVE
Mailing Address - Street 2:
Mailing Address - City:WEST HARTFORD
Mailing Address - State:CT
Mailing Address - Zip Code:06110
Mailing Address - Country:US
Mailing Address - Phone:860-233-2639
Mailing Address - Fax:860-236-3431
Practice Address - Street 1:1170 NEW BRITAIN AVE
Practice Address - Street 2:
Practice Address - City:WEST HARTFORD
Practice Address - State:CT
Practice Address - Zip Code:06110-2410
Practice Address - Country:US
Practice Address - Phone:860-233-2639
Practice Address - Fax:860-236-3431
Is Sole Proprietor?:Yes
Enumeration Date:2006-07-25
Last Update Date:2010-05-01
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CT023016207R00000X
CT23016207R00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207R00000XAllopathic & Osteopathic PhysiciansInternal Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
CT1230168Medicaid
D02579Medicare UPIN
CT1230168Medicaid