1124353784 NPI number — DR. BENJAMIN NATHAN HOFFMAN M.D.

Table of content: DR. BENJAMIN NATHAN HOFFMAN M.D. (NPI 1124353784)

General

This information contains only most important part of the NPI data, for complete information, including NPI referencing materials please refer to 1124353784 NPI number — DR. BENJAMIN NATHAN HOFFMAN M.D.

Organization/Personal Information

Employer Identification Number (EIN):
Provider Organization Name:
Provider Last Name:
HOFFMAN
Provider First Name:
BENJAMIN
Provider Middle Name:
NATHAN
Provider Name Prefix Text:
DR.
Provider Name Suffix Text:
Provider Credential Text:
M.D.
Provider Gender Code:
M

Provider's Other Name Information

Provider Other Organization Name:
Provider Other Organization Name Type Code:
Provider Other Last Name:
Provider Other First Name:
Provider Other Middle Name:
Provider Other Name Prefix Text:
Provider Other Name Suffix Text:
Provider Other Credential Text:
Provider Other Last Name Type Code:

NPI Number Information

NPI Number:
1124353784
Entity Type Code:
Individual
Replacement NPI:
Last Update Date:
07/20/2015
NPI Deactivation Reason Code:
NPI Deactivation Date:
NPI Reactivation Date:

Provider's Business Mailing Address

Provider First Line Business Mailing Address:
5700 LAKE WORTH RD
Provider Second Line Business Mailing Address:
STE 204
Provider Business Mailing Address City Name:
LAKE WORTH
Provider Business Mailing Address State Name:
FL
Provider Business Mailing Address Postal Code:
33463
Provider Business Mailing Address Country Code:
US
Provider Business Mailing Address Telephone Number:
561-966-7707
Provider Business Mailing Address Fax Number:

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
3918 VIA POINCIANA
Provider Second Line Business Practice Location Address:
STE 8
Provider Business Practice Location Address City Name:
LAKE WORTH
Provider Business Practice Location Address State Name:
FL
Provider Business Practice Location Address Postal Code:
33463
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
561-964-3700
Provider Business Practice Location Address Fax Number:
561-641-2484
Provider Enumeration Date:
10/14/2009

Additional Information

Authorized Official

Authorized Official Last Name:
Authorized Official First Name:
Authorized Official Middle Name:
Authorized Official Title or Position:
Authorized Official Telephone Number:

Provider Taxonomy Codes

  • Taxonomy code: 207R00000X , with the licence number:  ME 104206 , registered in the state of FL ; information, associated with the NPI states the following Primary Taxonomy Switch: "Y" .

Other Provider's Identifiers (legacy, non-NPI)





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