Provider Demographics
NPI:1306915996
Name:METRO OBA MEDICAL SERVICES, PC
Entity type:Organization
Organization Name:METRO OBA MEDICAL SERVICES, PC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:
Authorized Official - First Name:MARSHALL
Authorized Official - Middle Name:
Authorized Official - Last Name:GARLAND
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:800-344-3263
Mailing Address - Street 1:2 CATHARINE ST
Mailing Address - Street 2:METRO OBA MEDICAL SERVICES
Mailing Address - City:POUGHKEEPSIE
Mailing Address - State:NY
Mailing Address - Zip Code:12601-3100
Mailing Address - Country:US
Mailing Address - Phone:800-344-3263
Mailing Address - Fax:845-790-2675
Practice Address - Street 1:30 E 60TH ST
Practice Address - Street 2:PAUL DRUCKER, DPM STE 404
Practice Address - City:NEW YORK
Practice Address - State:NY
Practice Address - Zip Code:10022-1008
Practice Address - Country:US
Practice Address - Phone:212-688-8492
Practice Address - Fax:845-790-2675
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-11-07
Last Update Date:2022-07-21
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY207L00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes207L00000XAllopathic & Osteopathic PhysiciansAnesthesiologyGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
NYWCW091Medicare ID - Type Unspecified