Healthcare Provider Details

I. General information

NPI: 1447256508
Provider Name (Legal Business Name): BARRY S OBADIAH M.D.
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 06/23/2005
Last Update Date: 03/27/2014
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

2318 31ST ST
ASTORIA NY
11105-2892
US

IV. Provider business mailing address

2318 31ST ST
ASTORIA NY
11105-2892
US

V. Phone/Fax

Practice location:
  • Phone: 718-932-6000
  • Fax: 718-932-3194
Mailing address:
  • Phone: 718-932-6000
  • Fax: 718-932-3194

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code207RG0100X
TaxonomyGastroenterology Physician
License Number199214
License Number StateNY

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: