Provider Demographics
NPI:1568599447
Name:OHEBSHALOM, MICHAEL (MD)
Entity Type:Individual
Prefix:DR
First Name:MICHAEL
Middle Name:
Last Name:OHEBSHALOM
Suffix:
Gender:M
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:315 E SHORE RD
Mailing Address - Street 2:
Mailing Address - City:MANHASSET
Mailing Address - State:NY
Mailing Address - Zip Code:11030-2923
Mailing Address - Country:US
Mailing Address - Phone:516-487-5577
Mailing Address - Fax:516-487-2947
Practice Address - Street 1:315 E SHORE RD
Practice Address - Street 2:
Practice Address - City:MANHASSET
Practice Address - State:NY
Practice Address - Zip Code:11030-2923
Practice Address - Country:US
Practice Address - Phone:516-487-5577
Practice Address - Fax:516-487-2947
Is Sole Proprietor?:No
Enumeration Date:2007-02-27
Last Update Date:2022-12-13
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY228138174400000X, 208800000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes208800000XAllopathic & Osteopathic PhysiciansUrology
No174400000XOther Service ProvidersSpecialist
Provider Identifiers
StateIdentifier IDID TypeIssuer
NY04172HOtherGHI MEDICARE
NY02866177Medicaid
NY04172HOtherGHI MEDICARE