Provider Demographics
NPI:1023188596
Name:OSWEGO COUNTY UROLOGY PC
Entity Type:Organization
Organization Name:OSWEGO COUNTY UROLOGY PC
Other - Org Name:DR FELIZ OBEN MD
Other - Org Type:Other Name
Authorized Official - Title/Position:PHYSICIAN
Authorized Official - Prefix:
Authorized Official - First Name:FELIX
Authorized Official - Middle Name:TAKOR
Authorized Official - Last Name:OBEN
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:315-592-7375
Mailing Address - Street 1:826 HOLLY DR
Mailing Address - Street 2:
Mailing Address - City:FULTON
Mailing Address - State:NY
Mailing Address - Zip Code:13069
Mailing Address - Country:US
Mailing Address - Phone:315-592-7375
Mailing Address - Fax:315-598-8664
Practice Address - Street 1:826 HOLLY DR
Practice Address - Street 2:
Practice Address - City:FULTON
Practice Address - State:NY
Practice Address - Zip Code:13069
Practice Address - Country:US
Practice Address - Phone:315-592-7375
Practice Address - Fax:315-598-8664
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-11-09
Last Update Date:2020-08-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY234270208800000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes208800000XAllopathic & Osteopathic PhysiciansUrologyGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
NY02592881Medicaid
NYRA5376Medicare ID - Type Unspecified
NY02592881Medicaid