Provider Demographics
NPI:1588729222
Name:HOFFMAN, BRUCE SCOTT (PSYD)
Entity type:Individual
Prefix:DR
First Name:BRUCE
Middle Name:SCOTT
Last Name:HOFFMAN
Suffix:
Gender:M
Credentials:PSYD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1470 E 70TH ST
Mailing Address - Street 2:
Mailing Address - City:BROOKLYN
Mailing Address - State:NY
Mailing Address - Zip Code:11234-5712
Mailing Address - Country:US
Mailing Address - Phone:718-968-9557
Mailing Address - Fax:347-374-4193
Practice Address - Street 1:1470 E 70TH ST
Practice Address - Street 2:
Practice Address - City:BROOKLYN
Practice Address - State:NY
Practice Address - Zip Code:11234-5712
Practice Address - Country:US
Practice Address - Phone:718-968-9557
Practice Address - Fax:347-374-4193
Is Sole Proprietor?:Yes
Enumeration Date:2006-12-22
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY012887-1103TC0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes103TC0700XBehavioral Health & Social Service ProvidersPsychologistClinical
Provider Identifiers
StateIdentifier IDID TypeIssuer
NY01742209Medicaid
NY01742209Medicaid