Provider Demographics
NPI:1912189283
Name:OBER, BONIFACIO D (RPT)
Entity Type:Individual
Prefix:
First Name:BONIFACIO
Middle Name:D
Last Name:OBER
Suffix:
Gender:M
Credentials:RPT
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:562 OXFORD RD
Mailing Address - Street 2:
Mailing Address - City:CEDARHURST
Mailing Address - State:NY
Mailing Address - Zip Code:11516-1023
Mailing Address - Country:US
Mailing Address - Phone:516-295-2732
Mailing Address - Fax:
Practice Address - Street 1:562 OXFORD RD
Practice Address - Street 2:
Practice Address - City:CEDARHURST
Practice Address - State:NY
Practice Address - Zip Code:11516-1023
Practice Address - Country:US
Practice Address - Phone:516-295-2732
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2007-11-28
Last Update Date:2012-09-11
Deactivation Date:2011-04-19
Deactivation Code:
Reactivation Date:2012-03-22
Provider Licenses
StateLicense IDTaxonomies
NY022833225100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225100000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical Therapist