Healthcare Provider Details

I. General information

NPI: 1255601704
Provider Name (Legal Business Name): THOMAS PATRICK HOBAN
Entity Type: Individual
Gender: Male
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 12/30/2011
Last Update Date: 12/30/2011
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

23 E GREENWOOD AVE
VILLAS NJ
08251-1918
US

IV. Provider business mailing address

23 E GREENWOOD AVE
VILLAS NJ
08251-1918
US

V. Phone/Fax

Practice location:
  • Phone: 609-317-3656
  • Fax:
Mailing address:
  • Phone: 609-317-3656
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code163WR0006X
TaxonomyRegistered Nurse First Assistant
License Number26NO10170900
License Number StateNJ

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: