Provider Demographics
NPI:1457608168
Name:HOFMAN, ANGELA ROSE (LAC LMT)
Entity type:Individual
Prefix:MS
First Name:ANGELA
Middle Name:ROSE
Last Name:HOFMAN
Suffix:
Gender:F
Credentials:LAC LMT
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:107 NORTHERN BLVD
Mailing Address - Street 2:SUITE 307
Mailing Address - City:GREAT NECK
Mailing Address - State:NY
Mailing Address - Zip Code:11021-4311
Mailing Address - Country:US
Mailing Address - Phone:516-375-5305
Mailing Address - Fax:
Practice Address - Street 1:107 NORTHERN BLVD
Practice Address - Street 2:SUITE 307
Practice Address - City:GREAT NECK
Practice Address - State:NY
Practice Address - Zip Code:11021-4311
Practice Address - Country:US
Practice Address - Phone:516-375-5305
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2012-08-13
Last Update Date:2023-06-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY019629-1225700000X
FL98745225700000X
NY004307-1171100000X
FL4477171100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes171100000XOther Service ProvidersAcupuncturist
No225700000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersMassage Therapist