Provider Demographics
NPI:1023047495
Name:O'BRIEN, PATRICIA (DC)
Entity type:Individual
Prefix:
First Name:PATRICIA
Middle Name:
Last Name:O'BRIEN
Suffix:
Gender:F
Credentials:DC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:321 YALE AVE
Mailing Address - Street 2:A
Mailing Address - City:STRATFORD
Mailing Address - State:NJ
Mailing Address - Zip Code:08084-1247
Mailing Address - Country:US
Mailing Address - Phone:856-782-7500
Mailing Address - Fax:856-782-0075
Practice Address - Street 1:321 YALE AVE
Practice Address - Street 2:A
Practice Address - City:STRATFORD
Practice Address - State:NJ
Practice Address - Zip Code:08084-1247
Practice Address - Country:US
Practice Address - Phone:856-782-7500
Practice Address - Fax:856-782-0075
Is Sole Proprietor?:No
Enumeration Date:2006-06-30
Last Update Date:2012-05-02
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NJ38MC00419800111N00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes111N00000XChiropractic ProvidersChiropractor
Provider Identifiers
StateIdentifier IDID TypeIssuer
NJ1037744OtherAMERICAN SPECALTY PIN
NJ2364020OtherAETNA HMO
NJ0151772000OtherAH, KEYSTN, PC GRP PIN
NJ0207600000OtherAH, KEYSTN, PC INDIVD PIN
NJ2632234OtherOXFORD PIN
NJ11081097OtherCIGNA PIN
NJ0207600000OtherAH, KEYSTN, PC INDIVD PIN
NJ11081097OtherCIGNA PIN
NJ223701133OtherTAX ID NUMBER