Healthcare Provider Details

I. General information

NPI: 1417710260
Provider Name (Legal Business Name): JOHN WILLIAM OBRIEN PMHNP-BC
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 02/05/2024
Last Update Date: 04/28/2025
Certification Date: 04/28/2025
Deactivation Date:
Reactivation Date:

III. Provider practice location address

94-98 MANHATTAN AVENUE
BROOKLYN NY
11206-2505
US

IV. Provider business mailing address

60 MADISON AVE FL 5
NEW YORK NY
10010-1600
US

V. Phone/Fax

Practice location:
  • Phone: 718-388-0390
  • Fax: 718-486-5741
Mailing address:
  • Phone: 866-246-8259
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code363LP0808X
TaxonomyPsychiatric/Mental Health Nurse Practitioner
License Number2023089534
License Number StateDE
# 2
Primary TaxonomyY
Taxonomy Code363LP0808X
TaxonomyPsychiatric/Mental Health Nurse Practitioner
License Number405964
License Number StateNY

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: