Healthcare Provider Details

I. General information

NPI: 1609877166
Provider Name (Legal Business Name): MARK P HOBAICA DPM
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 08/09/2005
Last Update Date: 07/29/2010
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

2315 GENESEE ST
UTICA NY
13501-6107
US

IV. Provider business mailing address

2315 GENESEE ST
UTICA NY
13501-6107
US

V. Phone/Fax

Practice location:
  • Phone: 315-735-0237
  • Fax: 315-732-8695
Mailing address:
  • Phone: 315-735-0237
  • Fax: 315-732-8695

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code213ES0103X
TaxonomyFoot & Ankle Surgery Podiatrist
License Number003863-1
License Number StateNY

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: