Healthcare Provider Details

I. General information

NPI: 1659546620
Provider Name (Legal Business Name): ERIC S OBADIA DC
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 04/29/2008
Last Update Date: 05/06/2008
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

129 10 23RD AVE
COLLEGE POINT NY
11356
US

IV. Provider business mailing address

150 38 UNION TURNPIKE 12S
FLUSHING NY
11367
US

V. Phone/Fax

Practice location:
  • Phone: 718-463-1166
  • Fax: 718-463-1081
Mailing address:
  • Phone: 631-827-7418
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code111N00000X
TaxonomyChiropractor
License NumberX005974
License Number StateNY

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: