Basic Information
| Provider Information | |||||||||
| NPI: | 1902235872 | ||||||||
| EntityType: | 2 | ||||||||
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| OrganizationName: | METRO OBA MEDICAL SERVICES PC | ||||||||
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| Mailing Information | |||||||||
| Address1: | 2 CATHARINE STREET | ||||||||
| Address2: | PO BOX 550 | ||||||||
| City: | POUGHKEEPSIE | ||||||||
| State: | NY | ||||||||
| PostalCode: | 126020550 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 8457902672 | ||||||||
| FaxNumber: | 8457902613 | ||||||||
| Practice Location | |||||||||
| Address1: | 15 01 POLLITT DRIVE | ||||||||
| Address2: | UNITE 8B | ||||||||
| City: | FAIRLAWN | ||||||||
| State: | NJ | ||||||||
| PostalCode: | 07410 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 8457902672 | ||||||||
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| Other Information | |||||||||
| ProviderEnumerationDate: | 11/01/2013 | ||||||||
| LastUpdateDate: | 11/01/2013 | ||||||||
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| AuthorizedOfficialLastName: | FORMISANO | ||||||||
| AuthorizedOfficialFirstName: | CAROL | ||||||||
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| AuthorizedOfficialTitleorPosition: | MANAGER | ||||||||
| AuthorizedOfficialTelephone: | 8457902672 | ||||||||
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| IsOrganizationSubpart: | N | ||||||||
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Taxonomy Information
| Taxonomy | License | State | Switch | TaxonomyGroup | TaxonomyType | TaxonomyClass | SubSpecialty | 174400000X | 206251 | NY | Y | 193400000X SINGLE SPECIALTY GROUP | Other Service Providers | Specialist |
No ID Information.