Provider Demographics
NPI:1356674733
Name:OBERMAYER, GILLES S (LMT)
Entity Type:Individual
Prefix:MR
First Name:GILLES
Middle Name:S
Last Name:OBERMAYER
Suffix:
Gender:M
Credentials:LMT
Other - Prefix:
Other - First Name:
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Other - Credentials:
Mailing Address - Street 1:616 W 207TH ST
Mailing Address - Street 2:APT. 3K
Mailing Address - City:NEW YORK
Mailing Address - State:NY
Mailing Address - Zip Code:10034-2606
Mailing Address - Country:US
Mailing Address - Phone:917-282-7420
Mailing Address - Fax:646-935-2273
Practice Address - Street 1:245 5TH AVE
Practice Address - Street 2:2ND FLOOR
Practice Address - City:NEW YORK
Practice Address - State:NY
Practice Address - Zip Code:10016-8728
Practice Address - Country:US
Practice Address - Phone:917-282-7420
Practice Address - Fax:646-935-2273
Is Sole Proprietor?:No
Enumeration Date:2009-09-16
Last Update Date:2009-09-16
Deactivation Date:
Deactivation Code:
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Provider Licenses
StateLicense IDTaxonomies
NY022799225700000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225700000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersMassage Therapist
Provider Identifiers
StateIdentifier IDID TypeIssuer
NY022799OtherEDUCATION DEPARTMENT STATE OF NEW YORK