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 |