Provider Demographics
NPI:1558812297
Name:OBERG PSYCHIATRIC NURSE PRACTITIONER, PLLC
Entity type:Organization
Organization Name:OBERG PSYCHIATRIC NURSE PRACTITIONER, PLLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:
Authorized Official - First Name:LISA
Authorized Official - Middle Name:
Authorized Official - Last Name:OBERG
Authorized Official - Suffix:
Authorized Official - Credentials:NPP
Authorized Official - Phone:518-669-7434
Mailing Address - Street 1:16 LAKEVIEW RD
Mailing Address - Street 2:
Mailing Address - City:SARATOGA SPGS
Mailing Address - State:NY
Mailing Address - Zip Code:12866-8705
Mailing Address - Country:US
Mailing Address - Phone:518-669-7434
Mailing Address - Fax:518-871-1265
Practice Address - Street 1:2911 ROUTE 9
Practice Address - Street 2:
Practice Address - City:MALTA
Practice Address - State:NY
Practice Address - Zip Code:12020-3975
Practice Address - Country:US
Practice Address - Phone:518-871-1258
Practice Address - Fax:518-871-1265
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2016-10-18
Last Update Date:2016-10-18
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes251300000XAgenciesLocal Education Agency (LEA)