Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
Y | 103TC2200X | Clinical Child & Adolescent Psychologist | 014874-1 | NY |
NPI | 1083259485 |
---|---|
Provider Name | Dr. Russell Hoffman |
First Address | Bronx, NY 10463-2007 |
Second Address | Bronx, NY 10463-2007 |
Gender | M |
NPI Entity type | Individual |
Is Sole Proprietor | Yes |
Is Organization Subpart | N/A |
Enumeration Date | 10/11/2019 |
Last Update Date | 10/11/2019 |