Provider Demographics
NPI:1609011931
Name:BOBIS, MIDAS ELONA (PT)
Entity Type:Individual
Prefix:MS
First Name:MIDAS
Middle Name:ELONA
Last Name:BOBIS
Suffix:
Gender:F
Credentials:PT
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:6918 59TH RD
Mailing Address - Street 2:
Mailing Address - City:MASPETH
Mailing Address - State:NY
Mailing Address - Zip Code:11378-2920
Mailing Address - Country:US
Mailing Address - Phone:917-892-5129
Mailing Address - Fax:134-773-0597
Practice Address - Street 1:6918 59TH RD
Practice Address - Street 2:
Practice Address - City:MASPETH
Practice Address - State:NY
Practice Address - Zip Code:11378-2920
Practice Address - Country:US
Practice Address - Phone:917-892-5129
Practice Address - Fax:134-773-0597
Is Sole Proprietor?:Yes
Enumeration Date:2008-12-16
Last Update Date:2008-12-16
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY019458-1225100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225100000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical Therapist