Healthcare Provider Details

I. General information

NPI: 1316858285
Provider Name (Legal Business Name): OBELISK ENTERPRISES LLC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 09/16/2026
Last Update Date: 09/16/2026
Certification Date: 09/16/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

73 LAKELAND AVE
BABYLON NY
11702-1411
US

IV. Provider business mailing address

73 LAKELAND AVE
BABYLON NY
11702-1411
US

V. Phone/Fax

Practice location:
  • Phone: 516-647-3592
  • Fax:
Mailing address:
  • Phone: 516-647-3592
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code163W00000X
TaxonomyRegistered Nurse
License Number
License Number State

VIII. Authorized Official

Name: JEAN PHILIPPE DU BOUSQUET
Title or Position: OPERATING MANAGER
Credential:
Phone: 516-647-3592