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General NPI Number Information
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NPI Number | 1275853129
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Entity Type | Organization
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Legal Business Name | SHOBIN OOMMEN PHYSICIAN, PC
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Dates
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Enumeration Date | 06/02/2010
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Last Update Date | 06/02/2010
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Provider Practice Location Address
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Address Line | 35 PILGRIM ST
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City | NEW HYDE PARK
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State | NY
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Zip | 11040-3140
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Country | US
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Telephone | 917-797-4421
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Fax |
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Provider Business Mailing Address
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Address Line | 877 STEWART AVE SUITE 16
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City | GARDEN CITY
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State | NY
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Zip | 11530-4803
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Country | US
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Telephone | 516-745-6918
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Fax |
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Authorized Official
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Title or Position | MEDICAL DOCTOR
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Name | DR. SHOBIN OOMMEN
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Credential | MD
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Telephone | 917-797-4421
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 103K00000X
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Taxonomy Name | Behavior Analyst
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License Number | 246228
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License Number State | NY
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