Provider Demographics
| NPI: | 1356335343 |
|---|---|
| Name: | HOFFMAN, ERIC S |
| Entity type: | Individual |
| Prefix: | MR |
| First Name: | ERIC |
| Middle Name: | S |
| Last Name: | HOFFMAN |
| 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: | 7 ESCHER DR |
| Mailing Address - Street 2: | |
| Mailing Address - City: | MARLBORO |
| Mailing Address - State: | NJ |
| Mailing Address - Zip Code: | 07746-2223 |
| Mailing Address - Country: | US |
| Mailing Address - Phone: | 732-972-3698 |
| Mailing Address - Fax: | 732-972-9040 |
| Practice Address - Street 1: | 7 ESCHER DR |
| Practice Address - Street 2: | |
| Practice Address - City: | MARLBORO |
| Practice Address - State: | NJ |
| Practice Address - Zip Code: | 07746-2223 |
| Practice Address - Country: | US |
| Practice Address - Phone: | 732-972-3698 |
| Practice Address - Fax: | 732-972-9040 |
| Is Sole Proprietor?: | Yes |
| Enumeration Date: | 2005-09-06 |
| Last Update Date: | 2008-07-14 |
| Deactivation Date: | |
| Deactivation Code: | |
| Reactivation Date: |
Provider Licenses
| State | License ID | Taxonomies |
|---|---|---|
| NJ | PO 00001900 | 222Z00000X, 224P00000X |
Provider Taxonomies
| Primary? | Code | Type | Classification | Specialization |
|---|---|---|---|---|
| Yes | 222Z00000X | Respiratory, Developmental, Rehabilitative and Restorative Service Providers | Orthotist | |
| No | 224P00000X | Respiratory, Developmental, Rehabilitative and Restorative Service Providers | Prosthetist |
Provider Identifiers
| State | Identifier ID | ID Type | Issuer |
|---|---|---|---|
| NY | 00696355 | Medicaid | |
| NJ | 3252001 | Medicaid | |
| NJ | 3252001 | Medicaid |