Provider Demographics
NPI:1447551577
Name:KORNBLUH HOFFMANN, RIVKA (MS CCC SLP)
Entity type:Individual
Prefix:MRS
First Name:RIVKA
Middle Name:
Last Name:KORNBLUH HOFFMANN
Suffix:
Gender:F
Credentials:MS CCC SLP
Other - Prefix:
Other - First Name:RIVKA
Other - Middle Name:
Other - Last Name:KORNBLUH
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:
Mailing Address - Street 1:987 E 5TH ST
Mailing Address - Street 2:
Mailing Address - City:BROOKLYN
Mailing Address - State:NY
Mailing Address - Zip Code:11230-2613
Mailing Address - Country:US
Mailing Address - Phone:
Mailing Address - Fax:
Practice Address - Street 1:4421 15TH AVE
Practice Address - Street 2:
Practice Address - City:BROOKLYN
Practice Address - State:NY
Practice Address - Zip Code:11219-1604
Practice Address - Country:US
Practice Address - Phone:718-436-1122
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2010-11-05
Last Update Date:2010-11-27
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY017940235Z00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes235Z00000XSpeech, Language and Hearing Service ProvidersSpeech-Language Pathologist
Provider Identifiers
StateIdentifier IDID TypeIssuer
NYPZ62019YMedicaid