Provider Demographics
NPI:1801210430
Name:OBENG, DAVID (RN, BSN)
Entity Type:Individual
Prefix:MR
First Name:DAVID
Middle Name:
Last Name:OBENG
Suffix:
Gender:M
Credentials:RN, BSN
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:20 W MOSHOLU PKWY S APT 18A
Mailing Address - Street 2:
Mailing Address - City:BRONX
Mailing Address - State:NY
Mailing Address - Zip Code:10468-1135
Mailing Address - Country:US
Mailing Address - Phone:347-862-2911
Mailing Address - Fax:
Practice Address - Street 1:20 W MOSHOLU PKWY S APT 18A
Practice Address - Street 2:
Practice Address - City:BRONX
Practice Address - State:NY
Practice Address - Zip Code:10468-1135
Practice Address - Country:US
Practice Address - Phone:347-862-2911
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2014-02-18
Last Update Date:2014-03-15
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY680183163W00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes163W00000XNursing Service ProvidersRegistered Nurse