Healthcare Provider Details

I. General information

NPI: 1881812733
Provider Name (Legal Business Name): MARY GERALDINE HOBAN PHD
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 04/23/2007
Last Update Date: 07/08/2007
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

81 REMSEN STREET
BROOKLYN NY
11201
US

IV. Provider business mailing address

81 REMSEN STREET
BROOKLYN NY
11201
US

V. Phone/Fax

Practice location:
  • Phone: 718-875-3537
  • Fax: 914-709-2847
Mailing address:
  • Phone: 718-875-3537
  • Fax: 914-709-2847

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code103T00000X
TaxonomyPsychologist
License Number011202
License Number StateNY

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: