Provider Demographics
NPI:1013952530
Name:HOFFMEIER, HAROLD J JR (PA)
Entity Type:Individual
Prefix:MR
First Name:HAROLD
Middle Name:J
Last Name:HOFFMEIER
Suffix:JR
Gender:M
Credentials:PA
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
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Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:571 SAINT JOSEPHS BLVD FL 2
Mailing Address - Street 2:
Mailing Address - City:ELMIRA
Mailing Address - State:NY
Mailing Address - Zip Code:14901-3230
Mailing Address - Country:US
Mailing Address - Phone:607-271-2050
Mailing Address - Fax:
Practice Address - Street 1:104 S PORTER ST
Practice Address - Street 2:
Practice Address - City:WATKINS GLEN
Practice Address - State:NY
Practice Address - Zip Code:14891-1622
Practice Address - Country:US
Practice Address - Phone:607-535-7873
Practice Address - Fax:607-535-7469
Is Sole Proprietor?:No
Enumeration Date:2006-06-18
Last Update Date:2016-06-13
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY000251-1363A00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363A00000XPhysician Assistants & Advanced Practice Nursing ProvidersPhysician Assistant
Provider Identifiers
StateIdentifier IDID TypeIssuer
NY01277316Medicaid
NYJ400067054Medicare PIN
NY01277316Medicaid
NYDD5185Medicare ID - Type UnspecifiedINDIVIDUAL MEDICARE #