Provider Demographics
NPI:1013115617
Name:STEPHEN A OBSTBAUM MD PLLC
Entity Type:Organization
Organization Name:STEPHEN A OBSTBAUM MD PLLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:DR
Authorized Official - First Name:STEPHEN
Authorized Official - Middle Name:A
Authorized Official - Last Name:OBSTBAUM
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:646-521-0263
Mailing Address - Street 1:121 E 60TH ST
Mailing Address - Street 2:8TH FLOOR
Mailing Address - City:NEW YORK
Mailing Address - State:NY
Mailing Address - Zip Code:10022-1117
Mailing Address - Country:US
Mailing Address - Phone:646-521-0263
Mailing Address - Fax:646-521-0293
Practice Address - Street 1:121 E 60TH ST
Practice Address - Street 2:8TH FLOOR
Practice Address - City:NEW YORK
Practice Address - State:NY
Practice Address - Zip Code:10022-1117
Practice Address - Country:US
Practice Address - Phone:646-521-0263
Practice Address - Fax:646-521-0293
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2007-07-05
Last Update Date:2013-08-28
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY101642207W00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes207W00000XAllopathic & Osteopathic PhysiciansOphthalmologyGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
NY579721Medicare ID - Type Unspecified
NYB16845Medicare UPIN