Healthcare Provider Details

I. General information

NPI: 1932605151
Provider Name (Legal Business Name): KEVIN WILLIAM HOAG MD
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 04/05/2018
Last Update Date: 07/31/2024
Certification Date: 07/31/2024
Deactivation Date:
Reactivation Date:

III. Provider practice location address

254 EASTON AVE
NEW BRUNSWICK NJ
08901-1766
US

IV. Provider business mailing address

67 SUNSET AVE W
RED BANK NJ
07701-1433
US

V. Phone/Fax

Practice location:
  • Phone: 732-745-8600
  • Fax:
Mailing address:
  • Phone: 773-575-1900
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code207V00000X
TaxonomyObstetrics & Gynecology Physician
License Number25MA12143000
License Number StateNJ

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: