Healthcare Provider Details

I. General information

NPI: 1013112564
Provider Name (Legal Business Name): JESSIE OBADIA
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

Provider Other Name: YISKA OBADIA

II. Dates (important events)

Enumeration Date: 06/15/2007
Last Update Date: 04/10/2008
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

30 E 60TH ST SUITE 302
NEW YORK NY
10022-1008
US

IV. Provider business mailing address

265 E 66TH ST APT 2E
NEW YORK NY
10021-6404
US

V. Phone/Fax

Practice location:
  • Phone: 914-450-6692
  • Fax:
Mailing address:
  • Phone: 914-450-6692
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code171100000X
TaxonomyAcupuncturist
License Number003526
License Number StateNY

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: