MEDICARE: VIVIAN NUSSBAUM & LINDA OBERON PTRS

Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

#	Taxonomy Code	Taxonomy	License Number	License Number State
1	225100000X	Physical Therapist	4500-1	NY

Other Identifiers

#	Provider Identifier	Provider Identifier Type	Provider Identifier State	Provider Identifier Issuer
1	ANC734	OTHER	NY	OXFORD

General Provider Information

NPI Number	:	1134218522
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	VIVIAN NUSSBAUM & LINDA OBERON PTRS

Provider Business Mailing Address
First Line	:	250 W 93RD ST
Second Line	:	LOWER LEVEL
City	:	NEW YORK
State	:	NY
Zip	:	10025-7391
Country	:	US
Telephone Number	:	212-580-0125
Fax Number	:	212-580-0860

Provider Business Practice Location Address
First Line	:	250 W 93RD ST
Second Line	:	LOWER LEVEL
City	:	NEW YORK
State	:	NY
Zip	:	10025-7391
Country	:	US
Telephone Number	:	212-580-0125
Fax Number	:	212-580-0860

Authorized Official
Title or Position	:	OWNER/DIRECTOR
Name	:	LINDI OBERON
Credential	:	PT
Telephone Number	:	212-580-0125

Provider Enumeration Date	:	10/12/2006
Last Update Date	:	04/18/2013

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