MEDICARE: NATHANIEL OSBORN D.O.

Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

#	Taxonomy Code	Taxonomy	License Number	License Number State
1	207XS0114X	Adult Reconstructive Orthopaedic Surgery Physician	25MB12787200	NJ
2	207XS0114X	Adult Reconstructive Orthopaedic Surgery Physician	OS17563	FL
3	207X00000X	Orthopaedic Surgery Physician	81438	MN

Other Identifiers

#	Provider Identifier	Provider Identifier Type	Provider Identifier State	Provider Identifier Issuer
1	MEDICAID ID Found: Get Medicaid Details using Online Medicaid Verification Program
2	MEDICAID ID Found: Get Medicaid Details using Online Medicaid Verification Program

General Provider Information

NPI Number	:	1528412236
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	NATHANIEL OSBORN D.O.

Provider Business Mailing Address
First Line	:	115 EILEEN WAY
Second Line	:
City	:	SYOSSET
State	:	NY
Zip	:	11791-5323
Country	:	US
Telephone Number	:	516-795-3033
Fax Number	:	516-590-7684

Provider Business Practice Location Address
First Line	:	305 MEMORIAL MEDICAL PKWY STE 206
Second Line	:
City	:	DAYTONA BEACH
State	:	FL
Zip	:	32117-5169
Country	:	US
Telephone Number	:	863-231-4450
Fax Number	:	863-231-4456

Authorized Official
Title or Position	:
Name	:
Credential	:
Telephone Number	:

Provider Enumeration Date	:	04/19/2016
Last Update Date	:	12/21/2025

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Directions to “ NATHANIEL OSBORN D.O.” Practice Location

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