Healthcare Provider Details

I. General information

NPI: 1699950881
Provider Name (Legal Business Name): PHILIP J OBIEDZINSKI DPM PA
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 01/07/2008
Last Update Date: 03/08/2011
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

50 ORIENT WAY
RUTHERFORD NJ
07070
US

IV. Provider business mailing address

50 ORIENT WAY
RUTHERFORD NJ
07070
US

V. Phone/Fax

Practice location:
  • Phone: 201-939-2774
  • Fax: 201-935-6812
Mailing address:
  • Phone: 201-939-2774
  • Fax: 201-935-6812

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code213E00000X
TaxonomyPodiatrist
License Number25MD00126000
License Number StateNJ

VIII. Authorized Official

Name: DR. PHILIP J OBIEDZINSKI
Title or Position: PODIATRIST
Credential: DPM
Phone: 201-939-2774