Provider Demographics
NPI:1881716389
Name:O'BRIEN & THOMPSON MD PC
Entity type:Organization
Organization Name:O'BRIEN & THOMPSON MD PC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OFFICE MANAGER
Authorized Official - Prefix:MS
Authorized Official - First Name:SUZETTE
Authorized Official - Middle Name:
Authorized Official - Last Name:NITZSCHE
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:631-862-7062
Mailing Address - Street 1:403 LAKE AVE
Mailing Address - Street 2:
Mailing Address - City:SAINT JAMES
Mailing Address - State:NY
Mailing Address - Zip Code:11780-2205
Mailing Address - Country:US
Mailing Address - Phone:631-862-7062
Mailing Address - Fax:631-862-7114
Practice Address - Street 1:403 LAKE AVE
Practice Address - Street 2:
Practice Address - City:SAINT JAMES
Practice Address - State:NY
Practice Address - Zip Code:11780-2205
Practice Address - Country:US
Practice Address - Phone:631-862-7062
Practice Address - Fax:631-862-7114
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2007-04-04
Last Update Date:2008-01-16
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY154766-1174400000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes174400000XOther Service ProvidersSpecialistGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
NYWGB331Medicare PIN