1609179191 NPI number — MISS IRYN OBALDO FONTANOSA BSPT

Table of content: MISS IRYN OBALDO FONTANOSA BSPT (NPI 1609179191)

General

This information contains only most important part of the NPI data, for complete information, including NPI referencing materials please refer to 1609179191 NPI number — MISS IRYN OBALDO FONTANOSA BSPT

Organization/Personal Information

Employer Identification Number (EIN):
Provider Organization Name:
Provider Last Name:
FONTANOSA
Provider First Name:
IRYN
Provider Middle Name:
OBALDO
Provider Name Prefix Text:
MISS
Provider Name Suffix Text:
Provider Credential Text:
BSPT
Provider Gender Code:
F

Provider's Other Name Information

Provider Other Organization Name:
Provider Other Organization Name Type Code:
Provider Other Last Name:
OBALDO
Provider Other First Name:
IRYN
Provider Other Middle Name:
VINSON
Provider Other Name Prefix Text:
Provider Other Name Suffix Text:
Provider Other Credential Text:
BSPT
Provider Other Last Name Type Code:
1

NPI Number Information

NPI Number:
1609179191
Entity Type Code:
Individual
Replacement NPI:
Last Update Date:
09/01/2026
NPI Deactivation Reason Code:
NPI Deactivation Date:
NPI Reactivation Date:

Provider's Business Mailing Address

Provider First Line Business Mailing Address:
5 STORMYTOWN RD
Provider Second Line Business Mailing Address:
Provider Business Mailing Address City Name:
OSSINING
Provider Business Mailing Address State Name:
NY
Provider Business Mailing Address Postal Code:
10562-2510
Provider Business Mailing Address Country Code:
US
Provider Business Mailing Address Telephone Number:
914-707-4048
Provider Business Mailing Address Fax Number:

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
185 MAPLE AVENUE
Provider Second Line Business Practice Location Address:
SUITE 124
Provider Business Practice Location Address City Name:
WHITE PLAINS
Provider Business Practice Location Address State Name:
NY
Provider Business Practice Location Address Postal Code:
10601-4776
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
914-997-6970
Provider Business Practice Location Address Fax Number:
Provider Enumeration Date:
12/06/2010

Additional Information

Authorized Official

Authorized Official Last Name:
Authorized Official First Name:
Authorized Official Middle Name:
Authorized Official Title or Position:
Authorized Official Telephone Number:

Provider Taxonomy Codes

  • Taxonomy code: 225100000X , with the licence number:  62030274 , registered in the state of NY ; information, associated with the NPI states the following Primary Taxonomy Switch: "Y" .

Other Provider's Identifiers (legacy, non-NPI)





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