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General NPI Number Information
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NPI Number | 1881716389
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Entity Type | Organization
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Legal Business Name | O'BRIEN & THOMPSON MD PC
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Dates
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Enumeration Date | 04/04/2007
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Last Update Date | 01/16/2008
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Provider Practice Location Address
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Address Line | 403 LAKE AVE
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City | SAINT JAMES
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State | NY
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Zip | 11780-2205
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Country | US
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Telephone | 631-862-7062
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Fax | 631-862-7114
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Provider Business Mailing Address
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Address Line | 403 LAKE AVE
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City | SAINT JAMES
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State | NY
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Zip | 11780-2205
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Country | US
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Telephone | 631-862-7062
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Fax | 631-862-7114
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Authorized Official
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Title or Position | OFFICE MANAGER
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Name | MS. SUZETTE NITZSCHE
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Credential |
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Telephone | 631-862-7062
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 174400000X
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Taxonomy Name | Specialist
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License Number | 154766-1
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License Number State | NY
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