Provider Demographics
NPI:1417552712
Name:OBIEM, BERNARD OKYERE (LMT)
Entity Type:Individual
Prefix:
First Name:BERNARD
Middle Name:OKYERE
Last Name:OBIEM
Suffix:
Gender:M
Credentials:LMT
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:2125 PROSPECT AVE
Mailing Address - Street 2:
Mailing Address - City:EAST MEADOW
Mailing Address - State:NY
Mailing Address - Zip Code:11554-1935
Mailing Address - Country:US
Mailing Address - Phone:224-717-4801
Mailing Address - Fax:
Practice Address - Street 1:34 HEMPSTEAD TPKE
Practice Address - Street 2:
Practice Address - City:SOUTH FARMINGDALE
Practice Address - State:NY
Practice Address - Zip Code:11735-2034
Practice Address - Country:US
Practice Address - Phone:516-755-5855
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2020-12-03
Last Update Date:2020-12-03
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY032349-01225700000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes225700000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersMassage TherapistGroup - Single Specialty