Healthcare Provider Details

I. General information

NPI: 1124101944
Provider Name (Legal Business Name): SIDNEY ALEXANDER OBAS RPA-C
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 10/23/2006
Last Update Date: 07/08/2007
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

975 STEWART AVE
GARDEN CITY NY
11530-4816
US

IV. Provider business mailing address

166 BROWN AVENUE
HEMPSTEAD NY
11550
US

V. Phone/Fax

Practice location:
  • Phone: 516-267-6840
  • Fax: 516-267-6842
Mailing address:
  • Phone: 516-485-0196
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code363A00000X
TaxonomyPhysician Assistant
License Number009934
License Number StateNY

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: