Provider Demographics
NPI:1578989646
Name:AMERICAN MEDICAL
Entity Type:Organization
Organization Name:AMERICAN MEDICAL
Other - Org Name:KATHLEEN O'BRIEN
Other - Org Type:Other Name
Authorized Official - Title/Position:LPN
Authorized Official - Prefix:MISS
Authorized Official - First Name:KATHLEEN
Authorized Official - Middle Name:T
Authorized Official - Last Name:O'BRIEN
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:631-942-1671
Mailing Address - Street 1:469 15TH ST
Mailing Address - Street 2:
Mailing Address - City:WEST BABYLON
Mailing Address - State:NY
Mailing Address - Zip Code:11704-2610
Mailing Address - Country:US
Mailing Address - Phone:631-942-1671
Mailing Address - Fax:
Practice Address - Street 1:469 15TH ST
Practice Address - Street 2:
Practice Address - City:WEST BABYLON
Practice Address - State:NY
Practice Address - Zip Code:11704-2610
Practice Address - Country:US
Practice Address - Phone:631-942-1671
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:Yes
Parent Organization LBN:AMERICAN MEDICAL
Parent Organization TIN:<UNAVAIL>
Enumeration Date:2014-03-12
Last Update Date:2014-03-12
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY317181-1251E00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes251E00000XAgenciesHome Health