Provider Demographics
NPI:1578513107
Name:O'BRIEN, CATHERINE BRIDGET (NPP, APRN)
Entity Type:Individual
Prefix:MS
First Name:CATHERINE
Middle Name:BRIDGET
Last Name:O'BRIEN
Suffix:
Gender:F
Credentials:NPP, APRN
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:637 VETERANS HWY
Mailing Address - Street 2:
Mailing Address - City:SMITHTOWN
Mailing Address - State:NY
Mailing Address - Zip Code:11787-4309
Mailing Address - Country:US
Mailing Address - Phone:631-656-9761
Mailing Address - Fax:631-656-9765
Practice Address - Street 1:637 VETERANS HWY
Practice Address - Street 2:
Practice Address - City:SMITHTOWN
Practice Address - State:NY
Practice Address - Zip Code:11787-4309
Practice Address - Country:US
Practice Address - Phone:631-656-9761
Practice Address - Fax:631-656-9765
Is Sole Proprietor?:No
Enumeration Date:2006-05-12
Last Update Date:2015-01-12
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NYF400083363LP0808X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LP0808XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerPsychiatric/Mental Health
Provider Identifiers
StateIdentifier IDID TypeIssuer
NYS50531Medicare UPIN
NY007091Medicare ID - Type UnspecifiedMEDICARE PROVIDER NUMBER