Provider Demographics
NPI:1275883233
Name:OBIANG, BASSILLIA
Entity Type:Individual
Prefix:
First Name:BASSILLIA
Middle Name:
Last Name:OBIANG
Suffix:
Gender:F
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:493 E 46TH ST
Mailing Address - Street 2:
Mailing Address - City:BROOKLYN
Mailing Address - State:NY
Mailing Address - Zip Code:11203-4203
Mailing Address - Country:US
Mailing Address - Phone:347-406-4616
Mailing Address - Fax:
Practice Address - Street 1:493 E 46TH ST
Practice Address - Street 2:
Practice Address - City:BROOKLYN
Practice Address - State:NY
Practice Address - Zip Code:11203-4203
Practice Address - Country:US
Practice Address - Phone:347-406-4616
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2012-09-17
Last Update Date:2012-09-17
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes174400000XOther Service ProvidersSpecialist