Provider Demographics
NPI:1912184524
Name:THEO E. OBRIG, INC.
Entity Type:Organization
Organization Name:THEO E. OBRIG, INC.
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PRESIDENT
Authorized Official - Prefix:MRS
Authorized Official - First Name:SUSAN
Authorized Official - Middle Name:E
Authorized Official - Last Name:MAZURE
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:212-758-0973
Mailing Address - Street 1:209 E 56TH ST
Mailing Address - Street 2:LOWER LEVEL
Mailing Address - City:NEW YORK
Mailing Address - State:NY
Mailing Address - Zip Code:10022-3705
Mailing Address - Country:US
Mailing Address - Phone:212-758-0973
Mailing Address - Fax:212-980-8452
Practice Address - Street 1:209 E 56TH ST
Practice Address - Street 2:LOWER LEVEL
Practice Address - City:NEW YORK
Practice Address - State:NY
Practice Address - Zip Code:10022-3705
Practice Address - Country:US
Practice Address - Phone:212-758-0973
Practice Address - Fax:212-980-8452
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2008-01-25
Last Update Date:2008-10-31
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NYC003271-1332900000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes332900000XSuppliersNon-Pharmacy Dispensing Site
Provider Identifiers
StateIdentifier IDID TypeIssuer
NY0273610001Medicare NSC
0273610001Medicare PIN