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General NPI Number Information
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NPI Number | 1245654797
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Entity Type | Individual
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Provider Name | ROBERT J O'BRIEN III PA-C
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Gender | Male
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Dates
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Enumeration Date | 02/04/2014
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Last Update Date | 11/07/2024
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Provider Practice Location Address
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Address Line | 523 E 72ND ST FL 2
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City | NEW YORK
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State | NY
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Zip | 10021-4099
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Country | US
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Telephone | 212-606-1844
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Fax | 212-746-8744
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Provider Business Mailing Address
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Address Line | 535 E 70TH ST
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City | NEW YORK
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State | NY
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Zip | 10021-4823
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Country | US
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Telephone | 212-606-1844
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Fax | 212-746-8744
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Authorized Official
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Title or Position |
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Name |
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Credential |
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Telephone |
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 363A00000X
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Taxonomy Name | Physician Assistant
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License Number | 25MP00329700
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License Number State | NJ
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Taxonomy #2
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Taxonomy Code | 363A00000X
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Taxonomy Name | Physician Assistant
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License Number | 019211
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License Number State | NY
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