Healthcare Provider Details

I. General information

NPI: 1255502662
Provider Name (Legal Business Name): WARWICK MEDICAL ASSOCIATES LLP
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 03/13/2008
Last Update Date: 03/09/2015
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

5 GRAND ST
WARWICK NY
10990-1007
US

IV. Provider business mailing address

5 GRAND ST PO BOX 677
WARWICK NY
10990-1007
US

V. Phone/Fax

Practice location:
  • Phone: 845-986-7885
  • Fax: 845-986-7496
Mailing address:
  • Phone: 845-988-0899
  • Fax: 845-986-7496

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code207R00000X
TaxonomyInternal Medicine Physician
License Number
License Number State
# 2
Primary TaxonomyN
Taxonomy Code207RC0200X
TaxonomyCritical Care Medicine (Internal Medicine) Physician
License Number
License Number State
# 3
Primary TaxonomyN
Taxonomy Code207RG0300X
TaxonomyGeriatric Medicine (Internal Medicine) Physician
License Number
License Number State

VIII. Authorized Official

Name: DR. STEPHEN KOSTER HOVERMAN
Title or Position: PARTNER
Credential: M.D.
Phone: 845-988-0899