Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
N | 207R00000X | Internist | 145941 | NY |
N | 111NI0900X | Internist | 145941 | NY |
N | 207RC0200X | Critical Care Medicine | 145941 | NY |
N | 207RG0300X | Geriatric Medicine | 145941 | NY |
NPI | 1104926849 |
---|---|
Provider Name | Dr. Stephen Koster Hoverman |
First Address | Warwick, NY 10990-2864 |
Second Address | Warwick, NY 10990-0677 |
Gender | M |
NPI Entity type | Individual |
Is Sole Proprietor | No |
Is Organization Subpart | N/A |
Enumeration Date | 23/09/2006 |
Last Update Date | 08/07/2007 |
IDENTIFIER | TYPE / CODE | IDENTIFIER STATE |
---|---|---|
00595271 | (05) | NY |
B17044 | (02) |