Healthcare Provider Details

I. General information

NPI: 1285444760
Provider Name (Legal Business Name): PETER MCCANDLISH HOOVER PMHNP
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 01/08/2025
Last Update Date: 12/10/2025
Certification Date: 12/10/2025
Deactivation Date:
Reactivation Date:

III. Provider practice location address

80 8TH AVE
NEW YORK NY
10011-0607
US

IV. Provider business mailing address

80 8TH AVE
NEW YORK NY
10011-0607
US

V. Phone/Fax

Practice location:
  • Phone: 917-765-8579
  • Fax:
Mailing address:
  • Phone:
  • Fax: 929-744-1475

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code363LP0808X
TaxonomyPsychiatric/Mental Health Nurse Practitioner
License Number407187
License Number StateNY

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: