Provider Demographics
NPI:1184148470
Name:OBLICH, CHARLES D JR
Entity type:Individual
Prefix:MR
First Name:CHARLES
Middle Name:D
Last Name:OBLICH
Suffix:JR
Gender:M
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1203 SHELLS BUSH RD
Mailing Address - Street 2:
Mailing Address - City:LITTLE FALLS
Mailing Address - State:NY
Mailing Address - Zip Code:13365-6133
Mailing Address - Country:US
Mailing Address - Phone:315-508-5468
Mailing Address - Fax:
Practice Address - Street 1:1203 SHELLS BUSH ROAD
Practice Address - Street 2:
Practice Address - City:LITTLE FALLS
Practice Address - State:NY
Practice Address - Zip Code:13365
Practice Address - Country:US
Practice Address - Phone:315-508-5468
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2017-07-28
Last Update Date:2022-07-21
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes344600000XTransportation ServicesTaxi