Provider Demographics
NPI:1609179191
Name:OBALDO, IRYN VINSON (BSPT)
Entity Type:Individual
Prefix:MISS
First Name:IRYN
Middle Name:VINSON
Last Name:OBALDO
Suffix:
Gender:F
Credentials:BSPT
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:34 NORTH AVENUE
Mailing Address - Street 2:2ND FLOOR
Mailing Address - City:NEW ROCHELLE
Mailing Address - State:NY
Mailing Address - Zip Code:10805-3506
Mailing Address - Country:US
Mailing Address - Phone:570-809-1441
Mailing Address - Fax:
Practice Address - Street 1:185 MAPLE AVENUE
Practice Address - Street 2:SUITE 124
Practice Address - City:WHITE PLAINS
Practice Address - State:NY
Practice Address - Zip Code:10601-4776
Practice Address - Country:US
Practice Address - Phone:914-997-6970
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2010-12-06
Last Update Date:2010-12-06
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY62030274225100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225100000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical Therapist