Provider Demographics
NPI:1801246582
Name:OBM MEDICAL MANAGEMENT INC
Entity type:Organization
Organization Name:OBM MEDICAL MANAGEMENT INC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:CEO
Authorized Official - Prefix:
Authorized Official - First Name:CHANA
Authorized Official - Middle Name:
Authorized Official - Last Name:MIRSKY
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:718-614-2384
Mailing Address - Street 1:4864 ARTHUR KILL RD
Mailing Address - Street 2:
Mailing Address - City:STATEN ISLAND
Mailing Address - State:NY
Mailing Address - Zip Code:10309-2650
Mailing Address - Country:US
Mailing Address - Phone:718-317-2300
Mailing Address - Fax:718-356-4130
Practice Address - Street 1:3485 E TREMONT AVE
Practice Address - Street 2:
Practice Address - City:BRONX
Practice Address - State:NY
Practice Address - Zip Code:10465-2016
Practice Address - Country:US
Practice Address - Phone:718-828-1549
Practice Address - Fax:718-828-5029
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2016-06-14
Last Update Date:2021-06-14
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes302R00000XManaged Care OrganizationsHealth Maintenance OrganizationGroup - Multi-Specialty
No207R00000XAllopathic & Osteopathic PhysiciansInternal MedicineGroup - Multi-Specialty
No207V00000XAllopathic & Osteopathic PhysiciansObstetrics & GynecologyGroup - Multi-Specialty
No363L00000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerGroup - Multi-Specialty
No363LX0001XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerObstetrics & GynecologyGroup - Multi-Specialty