Basic Information
| Provider Information | |||||||||
| NPI: | 1720036247 | ||||||||
| EntityType: | 1 | ||||||||
| ReplacementNPI: | |||||||||
| OrganizationName: | |||||||||
| LastName: | ORBACH | ||||||||
| FirstName: | OZZIE | ||||||||
| MiddleName: | |||||||||
| NamePrefix: | |||||||||
| NameSuffix: | |||||||||
| Credential: | M.D. | ||||||||
| OtherOrganizationName: | |||||||||
| OtherOrganizationType: | |||||||||
| OtherLastName: | ORBACH | ||||||||
| OtherFirstName: | OZZIE | ||||||||
| OtherMiddleName: | |||||||||
| OtherNamePrefix: | DR. | ||||||||
| OtherNameSuffix: | |||||||||
| OtherCredential: | M.D. | ||||||||
| OtherLastNameType: | 2 | ||||||||
| Mailing Information | |||||||||
| Address1: | ST ALBANS VA | ||||||||
| Address2: | 179TH STREET AND LINDEN BLVD | ||||||||
| City: | ST ALBANS | ||||||||
| State: | NY | ||||||||
| PostalCode: | 11425 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 7185261000 | ||||||||
| FaxNumber: | |||||||||
| Practice Location | |||||||||
| Address1: | 179TH STREET AND LINDEN BLVD | ||||||||
| Address2: | |||||||||
| City: | ST ALBANS | ||||||||
| State: | NY | ||||||||
| PostalCode: | 11425 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 7185261000 | ||||||||
| FaxNumber: | |||||||||
| Other Information | |||||||||
| ProviderEnumerationDate: | 05/05/2006 | ||||||||
| LastUpdateDate: | 07/18/2007 | ||||||||
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| ProviderGenderCode: | M | ||||||||
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| AuthorizedOfficialMiddleName: | |||||||||
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| IsSoleProprietor: | N | ||||||||
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| NPICertificationDate: | |||||||||
Taxonomy Information
| Taxonomy | License | State | Switch | TaxonomyGroup | TaxonomyType | TaxonomyClass | SubSpecialty | 207R00000X | 150623 | NY | Y | Allopathic & Osteopathic Physicians | Internal Medicine | 207RE0101X | 150623 | NY | N | Allopathic & Osteopathic Physicians | Internal Medicine | Endocrinology, Diabetes & Metabolism |
No ID Information.