=====================================================
General NPI Number Information
=====================================================
NPI Number | 1831498310
-----------------------------------------------------
Entity Type | Organization
-----------------------------------------------------
Legal Business Name | ARNOLD C TOBACK MD PC
-----------------------------------------------------
=====================================================
Dates
=====================================================
Enumeration Date | 03/23/2011
-----------------------------------------------------
Last Update Date | 03/23/2011
-----------------------------------------------------
=====================================================
Provider Practice Location Address
=====================================================
Address Line | 2 E 69TH ST
-----------------------------------------------------
City | NEW YORK
-----------------------------------------------------
State | NY
-----------------------------------------------------
Zip | 10021-4906
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 212-737-1440
-----------------------------------------------------
Fax | 212-535-0573
-----------------------------------------------------
=====================================================
Provider Business Mailing Address
=====================================================
Address Line | 2 E 69TH ST
-----------------------------------------------------
City | NEW YORK
-----------------------------------------------------
State | NY
-----------------------------------------------------
Zip | 10021-4906
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 212-737-1440
-----------------------------------------------------
Fax | 212-535-0573
-----------------------------------------------------
=====================================================
Authorized Official
=====================================================
Title or Position | PRESIDENT
-----------------------------------------------------
Name | ARNOLD CHARLES TOBACK
-----------------------------------------------------
Credential | M.D.
-----------------------------------------------------
Telephone | 212-737-1440
-----------------------------------------------------
=====================================================
Scope of Practice (Provider's specialty)
=====================================================
Taxonomy #1
-----------------------------------------------------
Taxonomy Code | 207N00000X
-----------------------------------------------------
Taxonomy Name | Dermatology Physician
-----------------------------------------------------
License Number | 155647
-----------------------------------------------------
License Number State | NY
-----------------------------------------------------