Healthcare Provider Details

I. General information

NPI: 1962814210
Provider Name (Legal Business Name): ALEXANDER HOBERMAN MT-BC, LCAT
Entity Type: Individual
Gender: Male
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 05/21/2014
Last Update Date: 04/01/2019
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

202 W 40TH ST RM 403
NEW YORK NY
10018-2045
US

IV. Provider business mailing address

2225 38TH ST APT 2
ASTORIA NY
11105-1833
US

V. Phone/Fax

Practice location:
  • Phone: 914-573-7063
  • Fax:
Mailing address:
  • Phone: 914-573-7063
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code225A00000X
TaxonomyMusic Therapist
License Number001879-1
License Number StateNY

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: