Healthcare Provider Details

I. General information

NPI: 1366600512
Provider Name (Legal Business Name): EDWARD O HOBERMAN MA
Entity Type: Individual
Gender: Male
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 05/23/2008
Last Update Date: 05/23/2008
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

685 WEST END AVENUE
NEW YORK NY
10025-6819
US

IV. Provider business mailing address

685 WEST END AVENUE
NEW YORK NY
10025-6819
US

V. Phone/Fax

Practice location:
  • Phone: 212-666-9412
  • Fax:
Mailing address:
  • Phone: 212-666-9412
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code102L00000X
TaxonomyPsychoanalyst
License Number0001091
License Number StateNY

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: