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General NPI Number Information
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NPI Number | 1437754942
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Entity Type | Individual
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Provider Name | NEIL OBESO DPT
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Gender | Male
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Dates
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Enumeration Date | 12/02/2020
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Last Update Date | 12/02/2020
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Provider Practice Location Address
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Address Line | 97 MAIN ST STE H
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City | STONY BROOK
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State | NY
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Zip | 11790-1900
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Country | US
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Telephone | 631-751-6680
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Fax |
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Provider Business Mailing Address
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Address Line | 190 SOUND BEACH BLVD
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City | SOUND BEACH
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State | NY
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Zip | 11789-1644
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Country | US
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Telephone | 631-413-1757
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Fax |
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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 | 225100000X
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Taxonomy Name | Physical Therapist
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License Number | 046604-01
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License Number State | NY
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