Healthcare Provider Details

I. General information

NPI: 1629556139
Provider Name (Legal Business Name): LAUREN OBIJISKI
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 08/06/2018
Last Update Date: 03/22/2023
Certification Date: 03/22/2023
Deactivation Date:
Reactivation Date:

III. Provider practice location address

515 MOE RD
CLIFTON PARK NY
12065-3821
US

IV. Provider business mailing address

25 CORONADO WAY
BALLSTON SPA NY
12020-6342
US

V. Phone/Fax

Practice location:
  • Phone: 518-280-4294
  • Fax:
Mailing address:
  • Phone: 914-424-5033
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code225X00000X
TaxonomyOccupational Therapist
License Number
License Number State
# 2
Primary TaxonomyY
Taxonomy Code225X00000X
TaxonomyOccupational Therapist
License Number022006-01
License Number StateNY

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: