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General NPI Number Information
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NPI Number | 1912184524
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Entity Type | Organization
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Legal Business Name | THEO E. OBRIG, INC.
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Dates
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Enumeration Date | 01/25/2008
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Last Update Date | 10/31/2008
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Provider Practice Location Address
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Address Line | 209 E 56TH ST LOWER LEVEL
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City | NEW YORK
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State | NY
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Zip | 10022-3705
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Country | US
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Telephone | 212-758-0973
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Fax | 212-980-8452
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Provider Business Mailing Address
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Address Line | 209 E 56TH ST LOWER LEVEL
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City | NEW YORK
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State | NY
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Zip | 10022-3705
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Country | US
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Telephone | 212-758-0973
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Fax | 212-980-8452
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Authorized Official
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Title or Position | PRESIDENT
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Name | MRS. SUSAN E. MAZURE
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Credential |
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Telephone | 212-758-0973
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 332900000X
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Taxonomy Name | Non-Pharmacy Dispensing Site
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License Number | C003271-1
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License Number State | NY
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