Provider Demographics
NPI:1861541161
Name:HOFFMAN, MARK H (PT EDD)
Entity type:Individual
Prefix:DR
First Name:MARK
Middle Name:H
Last Name:HOFFMAN
Suffix:
Gender:M
Credentials:PT EDD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:3929 MORLOT AVENUE
Mailing Address - Street 2:
Mailing Address - City:FAIR LAWN
Mailing Address - State:NJ
Mailing Address - Zip Code:07410-4918
Mailing Address - Country:US
Mailing Address - Phone:201-475-4003
Mailing Address - Fax:201-475-4002
Practice Address - Street 1:3929 MORLOT AVENUE
Practice Address - Street 2:
Practice Address - City:FAIR LAWN
Practice Address - State:NJ
Practice Address - Zip Code:07410-4918
Practice Address - Country:US
Practice Address - Phone:201-475-4003
Practice Address - Fax:201-475-4002
Is Sole Proprietor?:No
Enumeration Date:2007-01-09
Last Update Date:2011-09-20
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NJNJ40QA00109500225100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225100000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical Therapist
Provider Identifiers
StateIdentifier IDID TypeIssuer
223584977OtherEIN
020530Medicare ID - Type Unspecified