Healthcare Provider Details

I. General information

NPI: 1417552712
Provider Name (Legal Business Name): BERNARD OKYERE OBIEM LMT
Entity Type: Individual
Gender: Male
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 12/03/2020
Last Update Date: 12/03/2020
Certification Date: 12/03/2020
Deactivation Date:
Reactivation Date:

III. Provider practice location address

34 HEMPSTEAD TPKE
SOUTH FARMINGDALE NY
11735-2034
US

IV. Provider business mailing address

2125 PROSPECT AVE
EAST MEADOW NY
11554-1935
US

V. Phone/Fax

Practice location:
  • Phone: 516-755-5855
  • Fax:
Mailing address:
  • Phone: 224-717-4801
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code225700000X
TaxonomyMassage Therapist
License Number032349-01
License Number StateNY

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: