1568815199 NPI number — MARSHA HOFFMANN RD, CDN

Table of content: MARSHA HOFFMANN RD, CDN (NPI 1568815199)

General

This information contains only most important part of the NPI data, for complete information, including NPI referencing materials please refer to 1568815199 NPI number — MARSHA HOFFMANN RD, CDN

Organization/Personal Information

Employer Identification Number (EIN):
Provider Organization Name:
Provider Last Name:
HOFFMANN
Provider First Name:
MARSHA
Provider Middle Name:
Provider Name Prefix Text:
Provider Name Suffix Text:
Provider Credential Text:
RD, CDN
Provider Gender Code:
F

Provider's Other Name Information

Provider Other Organization Name:
Provider Other Organization Name Type Code:
Provider Other Last Name:
SOMMERVIL
Provider Other First Name:
MARSHA
Provider Other Middle Name:
Provider Other Name Prefix Text:
Provider Other Name Suffix Text:
Provider Other Credential Text:
Provider Other Last Name Type Code:
1

NPI Number Information

NPI Number:
1568815199
Entity Type Code:
Individual
Replacement NPI:
Last Update Date:
05/08/2019
NPI Deactivation Reason Code:
NPI Deactivation Date:
NPI Reactivation Date:

Provider's Business Mailing Address

Provider First Line Business Mailing Address:
4500 PARSONS BLVD
Provider Second Line Business Mailing Address:
DEPT. OF FOOD & NUTRITION
Provider Business Mailing Address City Name:
FLUSHING
Provider Business Mailing Address State Name:
NY
Provider Business Mailing Address Postal Code:
11355-2205
Provider Business Mailing Address Country Code:
US
Provider Business Mailing Address Telephone Number:
718-670-5000
Provider Business Mailing Address Fax Number:
718-670-5614

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
4500 PARSONS BLVD
Provider Second Line Business Practice Location Address:
DEPT. OF FOOD & NUTRITION
Provider Business Practice Location Address City Name:
FLUSHING
Provider Business Practice Location Address State Name:
NY
Provider Business Practice Location Address Postal Code:
11355-2205
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
718-670-5000
Provider Business Practice Location Address Fax Number:
718-670-5614
Provider Enumeration Date:
07/19/2016

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: 133V00000X , with the licence number:  008587 , registered in the state of NY ; information, associated with the NPI states the following Primary Taxonomy Switch: "Y" .

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