Provider Demographics
NPI:1699950881
Name:PHILIP J OBIEDZINSKI DPM PA
Entity type:Organization
Organization Name:PHILIP J OBIEDZINSKI DPM PA
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PODIATRIST
Authorized Official - Prefix:DR
Authorized Official - First Name:PHILIP
Authorized Official - Middle Name:J
Authorized Official - Last Name:OBIEDZINSKI
Authorized Official - Suffix:
Authorized Official - Credentials:DPM
Authorized Official - Phone:201-939-2774
Mailing Address - Street 1:50 ORIENT WAY
Mailing Address - Street 2:
Mailing Address - City:RUTHERFORD
Mailing Address - State:NJ
Mailing Address - Zip Code:07070
Mailing Address - Country:US
Mailing Address - Phone:201-939-2774
Mailing Address - Fax:201-935-6812
Practice Address - Street 1:50 ORIENT WAY
Practice Address - Street 2:
Practice Address - City:RUTHERFORD
Practice Address - State:NJ
Practice Address - Zip Code:07070
Practice Address - Country:US
Practice Address - Phone:201-939-2774
Practice Address - Fax:201-935-6812
EIN:<UNAVAIL>
Is Organization Subpart?:Yes
Parent Organization LBN:PHILIP J OBIEDZINSKI DPM PA
Parent Organization TIN:<UNAVAIL>
Enumeration Date:2008-01-07
Last Update Date:2011-03-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NJ25MD00126000213E00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes213E00000XPodiatric Medicine & Surgery Service ProvidersPodiatristGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
NJ0150930001Medicare NSC