Provider Demographics
NPI:1134218522
Name:VIVIAN NUSSBAUM & LINDA OBERON PTRS
Entity type:Organization
Organization Name:VIVIAN NUSSBAUM & LINDA OBERON PTRS
Other - Org Name:<UNAVAIL>
Other - Org Type:
Authorized Official - Title/Position:OWNER/DIRECTOR
Authorized Official - Prefix:
Authorized Official - First Name:LINDI
Authorized Official - Middle Name:
Authorized Official - Last Name:OBERON
Authorized Official - Suffix:
Authorized Official - Credentials:PT
Authorized Official - Phone:212-580-0125
Mailing Address - Street 1:250 W 93RD ST
Mailing Address - Street 2:LOWER LEVEL
Mailing Address - City:NEW YORK
Mailing Address - State:NY
Mailing Address - Zip Code:10025-7391
Mailing Address - Country:US
Mailing Address - Phone:212-580-0125
Mailing Address - Fax:212-580-0860
Practice Address - Street 1:250 W 93RD ST
Practice Address - Street 2:LOWER LEVEL
Practice Address - City:NEW YORK
Practice Address - State:NY
Practice Address - Zip Code:10025-7391
Practice Address - Country:US
Practice Address - Phone:212-580-0125
Practice Address - Fax:212-580-0860
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-10-12
Last Update Date:2013-04-18
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY4500-1225100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes225100000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical TherapistGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
NYANC734OtherOXFORD
NYQ4W9W1Medicare ID - Type Unspecified