Provider Demographics
NPI:1063434298
Name:O'BRIEN, THOMAS GERARD II (DO)
Entity type:Individual
Prefix:DR
First Name:THOMAS
Middle Name:GERARD
Last Name:O'BRIEN
Suffix:II
Gender:M
Credentials:DO
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Mailing Address - Street 1:244 MADISON AVE
Mailing Address - Street 2:APT. 3G
Mailing Address - City:NEW YORK
Mailing Address - State:NY
Mailing Address - Zip Code:10016-2817
Mailing Address - Country:US
Mailing Address - Phone:516-330-4173
Mailing Address - Fax:
Practice Address - Street 1:121 E. 60TH ST.
Practice Address - Street 2:SUITE 4D
Practice Address - City:NEW YORK
Practice Address - State:NY
Practice Address - Zip Code:10065
Practice Address - Country:US
Practice Address - Phone:516-330-4173
Practice Address - Fax:718-412-3232
Is Sole Proprietor?:Yes
Enumeration Date:2006-07-24
Last Update Date:2014-11-18
Deactivation Date:
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Provider Licenses
StateLicense IDTaxonomies
NY210513207Q00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207Q00000XAllopathic & Osteopathic PhysiciansFamily Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
NY01971484Medicaid
NY07V53WT001Medicare PIN
NYG79589Medicare UPIN