Basic Information
| Provider Information | |||||||||
| NPI: | 1649572728 | ||||||||
| EntityType: | 2 | ||||||||
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| OrganizationName: | OSTEOPATHIC TREATMENT AND DIAGNOSTIC SERVICES, PC | ||||||||
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| Mailing Information | |||||||||
| Address1: | 26 FIREMENS MEMORIAL DR | ||||||||
| Address2: | SUITE 115 | ||||||||
| City: | POMONA | ||||||||
| State: | NY | ||||||||
| PostalCode: | 109703553 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 8453628400 | ||||||||
| FaxNumber: | 8453628474 | ||||||||
| Practice Location | |||||||||
| Address1: | 188 S MAIN ST | ||||||||
| Address2: | |||||||||
| City: | NEW CITY | ||||||||
| State: | NY | ||||||||
| PostalCode: | 109563318 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 8453584000 | ||||||||
| FaxNumber: | 8453628474 | ||||||||
| Other Information | |||||||||
| ProviderEnumerationDate: | 11/23/2010 | ||||||||
| LastUpdateDate: | 11/14/2013 | ||||||||
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| AuthorizedOfficialLastName: | UMBERGER | ||||||||
| AuthorizedOfficialFirstName: | DANIEL | ||||||||
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| AuthorizedOfficialTitleorPosition: | OWNER | ||||||||
| AuthorizedOfficialTelephone: | 8453584000 | ||||||||
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| IsOrganizationSubpart: | N | ||||||||
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| AuthorizedOfficialCredential: | DO | ||||||||
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Taxonomy Information
| Taxonomy | License | State | Switch | TaxonomyGroup | TaxonomyType | TaxonomyClass | SubSpecialty | 208100000X | Y | 193400000X SINGLE SPECIALTY GROUP | Allopathic & Osteopathic Physicians | Physical Medicine & Rehabilitation |
No ID Information.