Basic Information
| Provider Information | |||||||||
| NPI: | 1013002559 | ||||||||
| EntityType: | 1 | ||||||||
| ReplacementNPI: | |||||||||
| OrganizationName: | |||||||||
| LastName: | HOFFMAN | ||||||||
| FirstName: | IRA | ||||||||
| MiddleName: | R | ||||||||
| NamePrefix: | DR. | ||||||||
| NameSuffix: | |||||||||
| Credential: | M.D. | ||||||||
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| Mailing Information | |||||||||
| Address1: | 800A 5TH AVE | ||||||||
| Address2: | SUITE #301 | ||||||||
| City: | NEW YORK | ||||||||
| State: | NY | ||||||||
| PostalCode: | 100657215 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 2127557711 | ||||||||
| FaxNumber: | 2126882207 | ||||||||
| Practice Location | |||||||||
| Address1: | 800A 5TH AVE | ||||||||
| Address2: | SUITE #301 | ||||||||
| City: | NEW YORK | ||||||||
| State: | NY | ||||||||
| PostalCode: | 100657215 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 2127557711 | ||||||||
| FaxNumber: | 2126882207 | ||||||||
| Other Information | |||||||||
| ProviderEnumerationDate: | 10/03/2006 | ||||||||
| LastUpdateDate: | 10/02/2007 | ||||||||
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| ProviderGenderCode: | M | ||||||||
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| IsSoleProprietor: | Y | ||||||||
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Taxonomy Information
| Taxonomy | License | State | Switch | TaxonomyGroup | TaxonomyType | TaxonomyClass | SubSpecialty | 170100000X | 80118 | NY | Y | Other Service Providers | Medical Genetics, Ph.D. Medical Genetics |
ID Information
| ID | Type | State | Issuer | Description | 256911 | 01 | NY | MEDICARE ID | OTHER |