Provider Demographics
NPI:1003811019
Name:OBIEDZINSKI, PHILIP JOSEPH (DPM)
Entity Type:Individual
Prefix:DR
First Name:PHILIP
Middle Name:JOSEPH
Last Name:OBIEDZINSKI
Suffix:
Gender:M
Credentials:DPM
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:50 ORIENT WAY
Mailing Address - Street 2:
Mailing Address - City:RUTHERFORD
Mailing Address - State:NJ
Mailing Address - Zip Code:07070-2036
Mailing Address - Country:US
Mailing Address - Phone:201-939-2774
Mailing Address - Fax:201-935-6812
Practice Address - Street 1:50 ORIENT WAY
Practice Address - Street 2:
Practice Address - City:RUTHERFORD
Practice Address - State:NJ
Practice Address - Zip Code:07070-2036
Practice Address - Country:US
Practice Address - Phone:201-939-2774
Practice Address - Fax:201-935-6812
Is Sole Proprietor?:Yes
Enumeration Date:2005-06-16
Last Update Date:2011-03-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NJ25MD00126000213ES0103X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes213ES0103XPodiatric Medicine & Surgery Service ProvidersPodiatristFoot & Ankle Surgery
Provider Identifiers
StateIdentifier IDID TypeIssuer
NJT45130Medicare UPIN
NJ450468Medicare PIN