Healthcare Provider Details

I. General information

NPI: 1780029884
Provider Name (Legal Business Name): NATHAN M OBSTFELD PT
Entity Type: Individual
Gender: Male
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 05/02/2013
Last Update Date: 05/02/2013
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1901 1ST AVE
NEW YORK NY
10029-7404
US

IV. Provider business mailing address

1901 1ST AVE
NEW YORK NY
10029-7404
US

V. Phone/Fax

Practice location:
  • Phone: 212-423-6430
  • Fax:
Mailing address:
  • Phone: 212-423-8093
  • Fax: 212-423-6326

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code225100000X
TaxonomyPhysical Therapist
License Number035765
License Number StateNY

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: