Healthcare Provider Details

I. General information

NPI: 1447253000
Provider Name (Legal Business Name): LOUIS OBERGH II P.T.
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 05/27/2005
Last Update Date: 07/08/2007
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

400 N BROADWAY UNIT D
JERICHO NY
11753-2113
US

IV. Provider business mailing address

400 N BROADWAY UNIT D
JERICHO NY
11753-2113
US

V. Phone/Fax

Practice location:
  • Phone: 516-827-9446
  • Fax:
Mailing address:
  • Phone: 516-827-9446
  • Fax: 516-827-0042

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code225100000X
TaxonomyPhysical Therapist
License Number010372
License Number StateNY

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: