Provider Demographics
NPI:1609877166
Name:HOBAICA, MARK P (DPM)
Entity Type:Individual
Prefix:
First Name:MARK
Middle Name:P
Last Name:HOBAICA
Suffix:
Gender:M
Credentials:DPM
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:2315 GENESEE ST
Mailing Address - Street 2:
Mailing Address - City:UTICA
Mailing Address - State:NY
Mailing Address - Zip Code:13501-6107
Mailing Address - Country:US
Mailing Address - Phone:315-735-0237
Mailing Address - Fax:315-732-8695
Practice Address - Street 1:2315 GENESEE ST
Practice Address - Street 2:
Practice Address - City:UTICA
Practice Address - State:NY
Practice Address - Zip Code:13501-6107
Practice Address - Country:US
Practice Address - Phone:315-735-0237
Practice Address - Fax:315-732-8695
Is Sole Proprietor?:No
Enumeration Date:2005-08-09
Last Update Date:2010-07-29
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY003863-1213ES0103X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes213ES0103XPodiatric Medicine & Surgery Service ProvidersPodiatristFoot & Ankle Surgery
Provider Identifiers
StateIdentifier IDID TypeIssuer
NY00895836Medicaid
NY00895836Medicaid
NYRB8667Medicare PIN
NYRB8665Medicare PIN