Provider Demographics
NPI:1992752828
Name:HOFFMAN, JARED R (DC)
Entity type:Individual
Prefix:DR
First Name:JARED
Middle Name:R
Last Name:HOFFMAN
Suffix:
Gender:M
Credentials:DC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:729 WYTHE AVE
Mailing Address - Street 2:
Mailing Address - City:BROOKLYN
Mailing Address - State:NY
Mailing Address - Zip Code:11211-7820
Mailing Address - Country:US
Mailing Address - Phone:718-222-9700
Mailing Address - Fax:718-222-1879
Practice Address - Street 1:729 WYTHE AVE
Practice Address - Street 2:
Practice Address - City:BROOKLYN
Practice Address - State:NY
Practice Address - Zip Code:11211-7820
Practice Address - Country:US
Practice Address - Phone:718-222-9700
Practice Address - Fax:718-222-1879
Is Sole Proprietor?:No
Enumeration Date:2006-05-27
Last Update Date:2008-11-21
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NYX-010180-01111N00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes111N00000XChiropractic ProvidersChiropractor
Provider Identifiers
StateIdentifier IDID TypeIssuer
NY02577342Medicaid
NY6104700001Medicare NSC
NYX6G011Medicare PIN
NY02577342Medicaid