Provider Demographics
NPI:1104926849
Name:HOVERMAN, STEPHEN KOSTER (MD)
Entity type:Individual
Prefix:DR
First Name:STEPHEN
Middle Name:KOSTER
Last Name:HOVERMAN
Suffix:
Gender:M
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:21 CRYSTAL FARM RD
Mailing Address - Street 2:
Mailing Address - City:WARWICK
Mailing Address - State:NY
Mailing Address - Zip Code:10990-2864
Mailing Address - Country:US
Mailing Address - Phone:845-986-5279
Mailing Address - Fax:845-986-7496
Practice Address - Street 1:5 GRAND ST
Practice Address - Street 2:
Practice Address - City:WARWICK
Practice Address - State:NY
Practice Address - Zip Code:10990-0677
Practice Address - Country:US
Practice Address - Phone:845-986-7885
Practice Address - Fax:845-986-7496
Is Sole Proprietor?:No
Enumeration Date:2006-09-23
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY145941207R00000X, 207RC0200X, 207RG0300X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Not Answered207R00000XAllopathic & Osteopathic PhysiciansInternal Medicine
Not Answered207RC0200XAllopathic & Osteopathic PhysiciansInternal MedicineCritical Care Medicine
Not Answered207RG0300XAllopathic & Osteopathic PhysiciansInternal MedicineGeriatric Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
NY00595271Medicaid
B17044Medicare UPIN
60A271Medicare ID - Type Unspecified