Provider Demographics
NPI:1376608034
Name:OBLER, MARTIN (PHD)
Entity Type:Individual
Prefix:DR
First Name:MARTIN
Middle Name:
Last Name:OBLER
Suffix:
Gender:M
Credentials:PHD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:155 WEST 81ST.
Mailing Address - Street 2:SUITE 3A
Mailing Address - City:NEW YORK
Mailing Address - State:NY
Mailing Address - Zip Code:10024-7024
Mailing Address - Country:US
Mailing Address - Phone:212-673-0058
Mailing Address - Fax:631-725-9527
Practice Address - Street 1:155 WEST 81ST.
Practice Address - Street 2:SUITE 3A
Practice Address - City:NEW YORK
Practice Address - State:NY
Practice Address - Zip Code:10024-7024
Practice Address - Country:US
Practice Address - Phone:212-673-0058
Practice Address - Fax:631-725-9527
Is Sole Proprietor?:Yes
Enumeration Date:2006-12-23
Last Update Date:2009-02-23
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY4496103TC0700X
NY0044961103T00000X
NY004496-1103TC0700X, 103T00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes103TC0700XBehavioral Health & Social Service ProvidersPsychologistClinical
No103T00000XBehavioral Health & Social Service ProvidersPsychologist
Provider Identifiers
StateIdentifier IDID TypeIssuer
NY144913OtherVALUE OPTIONS PROVIDER NO
NY6893663OtherGHI PROVIDER NO
NYV13581Medicare UPIN
NYV13581Medicare PIN
NY144913OtherVALUE OPTIONS PROVIDER NO