Individual
MR. NICHOLAS ROGER OBIDIENZO III
Active
Sole proprietor
No
Provider details
NPI number
Gender
Man
Credential
OTR/L
Contact information
Practice address
15050 14TH RD, WHITESTONE, NY 11357-2609
(718) 767-0091
Mailing address
15050 14TH RD, WHITESTONE, NY 11357-2609
(718) 767-0091
Taxonomy
Speciality
Code
Description
License number
State
225XP0200X
Pediatric Occupational Therapist
Primary
020456-1
NY
Other
Enumeration date
05/18/2016
Last updated
05/18/2016
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