Healthcare Provider Details

I. General information

NPI: 1790608651
Provider Name (Legal Business Name): OBRIAN THOMAS
Entity Type: Individual
Gender: Male
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 07/30/2026
Last Update Date: 07/30/2026
Certification Date: 07/15/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

21 WEST END AVE
BROOKLYN NY
10023-7987
US

IV. Provider business mailing address

2093 RYER AVE
BRONX NY
10457-3147
US

V. Phone/Fax

Practice location:
  • Phone: 646-431-0472
  • Fax:
Mailing address:
  • Phone:
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code332B00000X
TaxonomyDurable Medical Equipment & Medical Supplies
License Number
License Number StateNY

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: