1457433294 NPI number — CHRISTOPHER WILLIAM O'BRIEN PHD, LAT, ATC

Table of content: CHRISTOPHER WILLIAM O'BRIEN PHD, LAT, ATC (NPI 1457433294)

General

This information contains only most important part of the NPI data, for complete information, including NPI referencing materials please refer to 1457433294 NPI number — CHRISTOPHER WILLIAM O'BRIEN PHD, LAT, ATC

Organization/Personal Information

Employer Identification Number (EIN):
Provider Organization Name:
Provider Last Name:
O'BRIEN
Provider First Name:
CHRISTOPHER
Provider Middle Name:
WILLIAM
Provider Name Prefix Text:
Provider Name Suffix Text:
Provider Credential Text:
PHD, LAT, ATC
Provider Gender Code:
M

Provider's Other Name Information

Provider Other Organization Name:
Provider Other Organization Name Type Code:
Provider Other Last Name:
Provider Other First Name:
Provider Other Middle Name:
Provider Other Name Prefix Text:
Provider Other Name Suffix Text:
Provider Other Credential Text:
Provider Other Last Name Type Code:

NPI Number Information

NPI Number:
1457433294
Entity Type Code:
Individual
Replacement NPI:
Last Update Date:
04/05/2019
NPI Deactivation Reason Code:
NPI Deactivation Date:
NPI Reactivation Date:

Provider's Business Mailing Address

Provider First Line Business Mailing Address:
627 MARY JO DR
Provider Second Line Business Mailing Address:
Provider Business Mailing Address City Name:
JESSUP
Provider Business Mailing Address State Name:
PA
Provider Business Mailing Address Postal Code:
18434-1965
Provider Business Mailing Address Country Code:
US
Provider Business Mailing Address Telephone Number:
570-430-9225
Provider Business Mailing Address Fax Number:

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
KING'S COLLEGE
Provider Second Line Business Practice Location Address:
133 NORTH RIVER STREET
Provider Business Practice Location Address City Name:
WILKES-BARRE
Provider Business Practice Location Address State Name:
PA
Provider Business Practice Location Address Postal Code:
18711
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
570-208-8404
Provider Business Practice Location Address Fax Number:
Provider Enumeration Date:
10/20/2006

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: 2255A2300X , with the licence number:  001603-1 , registered in the state of NY ; information, associated with the NPI states the following Primary Taxonomy Switch: "N" .
  • Taxonomy code: 2255A2300X , with the licence number: RT001243A , registered in the state of PA ; information, associated with the NPI states the following Primary Taxonomy Switch: "Y" .

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

  • Identifier: 001603-1 . This is a "OFFICE OF THE PROFESSIONS, THE UNIVERSITY OF THE STATE OF NY EDUCATION DEPT." identifier , issued by the state of ( NY ) . This identifiers is of the category "OTHER".
  • Identifier: RT001243A . This is a "BUREAU OF PROFESSIONAL AND OCCUPATIONAL AFFAIRS, PA DEPT. OF STATE" identifier , issued by the state of ( PA ) . This identifiers is of the category "OTHER".




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