Provider Demographics
NPI:1013112564
Name:OBADIA, JESSIE
Entity Type:Individual
Prefix:
First Name:JESSIE
Middle Name:
Last Name:OBADIA
Suffix:
Gender:F
Credentials:
Other - Prefix:
Other - First Name:YISKA
Other - Middle Name:
Other - Last Name:OBADIA
Other - Suffix:
Other - Last Name Type:Other Name
Other - Credentials:
Mailing Address - Street 1:265 E 66TH ST
Mailing Address - Street 2:APT 2E
Mailing Address - City:NEW YORK
Mailing Address - State:NY
Mailing Address - Zip Code:10021-6404
Mailing Address - Country:US
Mailing Address - Phone:914-450-6692
Mailing Address - Fax:
Practice Address - Street 1:30 E 60TH ST
Practice Address - Street 2:SUITE 302
Practice Address - City:NEW YORK
Practice Address - State:NY
Practice Address - Zip Code:10022-1008
Practice Address - Country:US
Practice Address - Phone:914-450-6692
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2007-06-15
Last Update Date:2008-04-10
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY003526171100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes171100000XOther Service ProvidersAcupuncturist