Provider Demographics
NPI:1235284373
Name:HOFMANN, PETER L (MD)
Entity type:Individual
Prefix:DR
First Name:PETER
Middle Name:L
Last Name:HOFMANN
Suffix:
Gender:M
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
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Other - Credentials:
Mailing Address - Street 1:620 FORT WASHINGTON AVE STE A
Mailing Address - Street 2:
Mailing Address - City:NEW YORK
Mailing Address - State:NY
Mailing Address - Zip Code:10040-3929
Mailing Address - Country:US
Mailing Address - Phone:212-795-2875
Mailing Address - Fax:212-795-2752
Practice Address - Street 1:620 FORT WASHINGTON AVE
Practice Address - Street 2:SUITE A
Practice Address - City:NEW YORK
Practice Address - State:NY
Practice Address - Zip Code:10040-3929
Practice Address - Country:US
Practice Address - Phone:212-795-2875
Practice Address - Fax:212-795-2752
Is Sole Proprietor?:Yes
Enumeration Date:2007-01-25
Last Update Date:2008-03-12
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY114035207R00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207R00000XAllopathic & Osteopathic PhysiciansInternal Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
NY01175126Medicaid
NY673781Medicare PIN
NYB78964Medicare UPIN