Basic Information
| Provider Information | |||||||||
| NPI: | 1194836692 | ||||||||
| EntityType: | 1 | ||||||||
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| OrganizationName: | |||||||||
| LastName: | HOFFMAN | ||||||||
| FirstName: | JACQUELYN | ||||||||
| MiddleName: | J | ||||||||
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| Credential: | RD CDE | ||||||||
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| Mailing Information | |||||||||
| Address1: | 711 TROY SCHENECTADY RD | ||||||||
| Address2: | SUITE 203 | ||||||||
| City: | LATHAM | ||||||||
| State: | NY | ||||||||
| PostalCode: | 121102442 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 5187823823 | ||||||||
| FaxNumber: | 5187823799 | ||||||||
| Practice Location | |||||||||
| Address1: | 713 TROY SCHENECTADY RD | ||||||||
| Address2: | SUITE 218 | ||||||||
| City: | LATHAM | ||||||||
| State: | NY | ||||||||
| PostalCode: | 121102490 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 5187823839 | ||||||||
| FaxNumber: | 5187823761 | ||||||||
| Other Information | |||||||||
| ProviderEnumerationDate: | 08/31/2006 | ||||||||
| LastUpdateDate: | 09/24/2007 | ||||||||
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| ProviderGenderCode: | F | ||||||||
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| IsSoleProprietor: | Y | ||||||||
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Taxonomy Information
| Taxonomy | License | State | Switch | TaxonomyGroup | TaxonomyType | TaxonomyClass | SubSpecialty | 133V00000X | 005808 | NY | Y | Dietary & Nutritional Service Providers | Dietitian, Registered |
No ID Information.