Healthcare Provider Details

I. General information

NPI: 1467080960
Provider Name (Legal Business Name): JORDAN ELIAS HOBAICA
Entity Type: Individual
Gender: Male
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 03/30/2020
Last Update Date: 01/16/2023
Certification Date: 01/16/2023
Deactivation Date:
Reactivation Date:

III. Provider practice location address

85 COLLEGE ST
HAMILTON NY
13346-1227
US

IV. Provider business mailing address

85 COLLEGE ST
HAMILTON NY
13346-1227
US

V. Phone/Fax

Practice location:
  • Phone: 315-824-1250
  • Fax: 315-824-8961
Mailing address:
  • Phone: 315-824-1250
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code363A00000X
TaxonomyPhysician Assistant
License Number025731
License Number StateNY

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: