Provider Demographics
NPI:1225085087
Name:CARLOS A OBREGON, D.O.,P.C.
Entity Type:Organization
Organization Name:CARLOS A OBREGON, D.O.,P.C.
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:DR
Authorized Official - First Name:CARLOS
Authorized Official - Middle Name:A
Authorized Official - Last Name:OBREGON
Authorized Official - Suffix:
Authorized Official - Credentials:DO
Authorized Official - Phone:856-218-8080
Mailing Address - Street 1:100A KINGS WAY W
Mailing Address - Street 2:
Mailing Address - City:SEWELL
Mailing Address - State:NJ
Mailing Address - Zip Code:08080-2235
Mailing Address - Country:US
Mailing Address - Phone:856-218-8080
Mailing Address - Fax:856-218-8070
Practice Address - Street 1:100A KINGS WAY W
Practice Address - Street 2:
Practice Address - City:SEWELL
Practice Address - State:NJ
Practice Address - Zip Code:08080-2235
Practice Address - Country:US
Practice Address - Phone:856-218-8080
Practice Address - Fax:856-218-8070
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-05-27
Last Update Date:2012-05-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes207RP1001XAllopathic & Osteopathic PhysiciansInternal MedicinePulmonary DiseaseGroup - Single Specialty
No207RC0200XAllopathic & Osteopathic PhysiciansInternal MedicineCritical Care MedicineGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
NJ8499608Medicaid
NJ8499608Medicaid