Provider Demographics
NPI:1568788990
Name:PHYSICIAN OFFICE BASED SURGERY
Entity Type:Organization
Organization Name:PHYSICIAN OFFICE BASED SURGERY
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:DR
Authorized Official - First Name:MANOJ
Authorized Official - Middle Name:T
Authorized Official - Last Name:ABRAHAM
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:845-454-8025
Mailing Address - Street 1:82 N WATER ST
Mailing Address - Street 2:
Mailing Address - City:POUGHKEEPSIE
Mailing Address - State:NY
Mailing Address - Zip Code:12601-1721
Mailing Address - Country:US
Mailing Address - Phone:845-454-8025
Mailing Address - Fax:845-454-8026
Practice Address - Street 1:82 N WATER ST
Practice Address - Street 2:
Practice Address - City:POUGHKEEPSIE
Practice Address - State:NY
Practice Address - Zip Code:12601-1721
Practice Address - Country:US
Practice Address - Phone:845-454-8025
Practice Address - Fax:845-454-8026
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2010-04-09
Last Update Date:2010-04-09
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes261QA1903XAmbulatory Health Care FacilitiesClinic/CenterAmbulatory Surgical