Healthcare Provider Details

I. General information

NPI: 1407307069
Provider Name (Legal Business Name): JORGE HOHEB M.S.
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 10/19/2016
Last Update Date: 11/25/2024
Certification Date: 10/21/2024
Deactivation Date:
Reactivation Date:

III. Provider practice location address

5840 FORTUNA DR
FARMINGTON NM
87402-8210
US

IV. Provider business mailing address

5040 JACOBUS ST
ELMHURST NY
11373-4803
US

V. Phone/Fax

Practice location:
  • Phone: 505-599-8625
  • Fax:
Mailing address:
  • Phone: 718-429-7006
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code235Z00000X
TaxonomySpeech-Language Pathologist
License Number6105
License Number StateNM
# 2
Primary TaxonomyY
Taxonomy Code235Z00000X
TaxonomySpeech-Language Pathologist
License Number026538
License Number StateNY

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: