Provider Demographics
NPI:1184628604
Name:OBSTBAUM, STEPHEN ALLAN (MD)
Entity type:Individual
Prefix:DR
First Name:STEPHEN
Middle Name:ALLAN
Last Name:OBSTBAUM
Suffix:
Gender:M
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
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Other - Credentials:
Mailing Address - Street 1:210 E 64TH ST
Mailing Address - Street 2:
Mailing Address - City:NEW YORK
Mailing Address - State:NY
Mailing Address - Zip Code:10065-7471
Mailing Address - Country:US
Mailing Address - Phone:212-702-7300
Mailing Address - Fax:212-702-7678
Practice Address - Street 1:115 E 39TH ST
Practice Address - Street 2:
Practice Address - City:NEW YORK
Practice Address - State:NY
Practice Address - Zip Code:10016-0943
Practice Address - Country:US
Practice Address - Phone:212-687-4106
Practice Address - Fax:212-983-6497
Is Sole Proprietor?:No
Enumeration Date:2005-06-13
Last Update Date:2013-09-04
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY101642207W00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207W00000XAllopathic & Osteopathic PhysiciansOphthalmology
Provider Identifiers
StateIdentifier IDID TypeIssuer
NYB16845Medicare UPIN
579721Medicare ID - Type Unspecified