Healthcare Provider Details

I. General information

NPI: 1457632580
Provider Name (Legal Business Name): DAVID MOBLEY M.D.
Entity Type: Individual
Gender: Male
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 09/02/2011
Last Update Date: 05/09/2017
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1 GUSTAVE L LEVY PL # 1234
NEW YORK NY
10029-6500
US

IV. Provider business mailing address

237 ELDRIDGE ST APT 34
NEW YORK NY
10002-1337
US

V. Phone/Fax

Practice location:
  • Phone: 212-241-1497
  • Fax:
Mailing address:
  • Phone: 917-566-4399
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code2085R0202X
TaxonomyDiagnostic Radiology Physician
License Number264888
License Number StateNY
# 2
Primary TaxonomyY
Taxonomy Code2085R0204X
TaxonomyVascular & Interventional Radiology Physician
License Number264888
License Number StateNY

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: