Provider Demographics
NPI:1962814210
Name:HOBERMAN, ALEXANDER (MT-BC, LCAT)
Entity Type:Individual
Prefix:
First Name:ALEXANDER
Middle Name:
Last Name:HOBERMAN
Suffix:
Gender:M
Credentials:MT-BC, LCAT
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:2225 38TH ST APT 2
Mailing Address - Street 2:
Mailing Address - City:ASTORIA
Mailing Address - State:NY
Mailing Address - Zip Code:11105-1833
Mailing Address - Country:US
Mailing Address - Phone:914-573-7063
Mailing Address - Fax:
Practice Address - Street 1:202 W 40TH ST RM 403
Practice Address - Street 2:
Practice Address - City:NEW YORK
Practice Address - State:NY
Practice Address - Zip Code:10018-2045
Practice Address - Country:US
Practice Address - Phone:914-573-7063
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2014-05-21
Last Update Date:2019-04-01
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY001879-1225A00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225A00000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersMusic Therapist