| Shobin Oommen Physician, Pc | |
|
35 Pilgrim St New Hyde Park NY 11040-3140 | |
| (917) 797-4421 | |
| Not Available |
| Full Name | Shobin Oommen Physician, Pc |
|---|---|
| Speciality | Behavior Analyst |
| Location | 35 Pilgrim St, New Hyde Park, New York |
| Authorized Official Name and Position | Shobin Oommen (MEDICAL DOCTOR) |
| Authorized Official Contact | 9177974421 |
| Accepts Medicare Insurance | Yes. This clinic participates in medicare program and accept medicare insurance. |
| Mailing Address | Practice Location Address |
|---|---|
| Shobin Oommen Physician, Pc 877 Stewart Ave Suite 16 Garden City NY 11530-4803 Ph: (516) 745-6918 | Shobin Oommen Physician, Pc 35 Pilgrim St New Hyde Park NY 11040-3140 Ph: (917) 797-4421 |
| NPI Number | 1275853129 |
|---|---|
| Provider Enumeration Date | 06/02/2010 |
| Last Update Date | 06/02/2010 |
| Medicare PECOS PAC ID | 5597946970 |
|---|---|
| Medicare Enrollment ID | O20110217000474 |
| Identifier | Type | State | Issuer |
|---|---|---|---|
| 1275853129 | NPI | - | NPPES |
| Taxonomy | Type | License (State) | Status |
|---|---|---|---|
| 103K00000X | Behavior Analyst | 246228 (New York) | Primary |
| Provider Name | Shobin Oommen |
|---|---|
| Provider Type | Practitioner - Psychiatry |
| Provider Identifiers | NPI Number: 1205035383 PECOS PAC ID: 6305937533 Enrollment ID: I20081106000518 |
| Provider Name | Michael Nuccitelli |
|---|---|
| Provider Type | Practitioner - Clinical Psychologist |
| Provider Identifiers | NPI Number: 1740303940 PECOS PAC ID: 6406126994 Enrollment ID: I20170717000488 |
| Provider Name | Yitzchok D Wagshul |
|---|---|
| Provider Type | Practitioner - Clinical Psychologist |
| Provider Identifiers | NPI Number: 1841769965 PECOS PAC ID: 4486991197 Enrollment ID: I20190201002445 |
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