Provider Demographics
NPI:1659546620
Name:OBADIA, ERIC S (DC)
Entity Type:Individual
Prefix:
First Name:ERIC
Middle Name:S
Last Name:OBADIA
Suffix:
Gender:M
Credentials:DC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:150 38 UNION TURNPIKE
Mailing Address - Street 2:12S
Mailing Address - City:FLUSHING
Mailing Address - State:NY
Mailing Address - Zip Code:11367
Mailing Address - Country:US
Mailing Address - Phone:631-827-7418
Mailing Address - Fax:
Practice Address - Street 1:129 10 23RD AVE
Practice Address - Street 2:
Practice Address - City:COLLEGE POINT
Practice Address - State:NY
Practice Address - Zip Code:11356
Practice Address - Country:US
Practice Address - Phone:718-463-1166
Practice Address - Fax:718-463-1081
Is Sole Proprietor?:No
Enumeration Date:2008-04-29
Last Update Date:2008-05-06
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NYX005974111N00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes111N00000XChiropractic ProvidersChiropractor
Provider Identifiers
StateIdentifier IDID TypeIssuer
NYCO59743BOtherWORK COMP
NYCO59743BOtherWORK COMP IME