Healthcare Provider Details

I. General information

NPI: 1184826018
Provider Name (Legal Business Name): JAMES P O'BRIEN PA
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 06/04/2007
Last Update Date: 07/21/2022
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1160 CORPORATE DR
FARMINGTON NY
14425-9534
US

IV. Provider business mailing address

191 MAIN ST
DELHI NY
13753-1040
US

V. Phone/Fax

Practice location:
  • Phone: 585-924-1510
  • Fax:
Mailing address:
  • Phone: 718-920-2961
  • Fax: 718-920-2058

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code363A00000X
TaxonomyPhysician Assistant
License Number003182
License Number StateNY

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: