Basic Information
| Provider Information | |||||||||
| NPI: | 1952463861 | ||||||||
| EntityType: | 1 | ||||||||
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| OrganizationName: | |||||||||
| LastName: | OBER | ||||||||
| FirstName: | DAVID | ||||||||
| MiddleName: | |||||||||
| NamePrefix: | DR. | ||||||||
| NameSuffix: | |||||||||
| Credential: | M.D. | ||||||||
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| Mailing Information | |||||||||
| Address1: | 20 GRAND ST FL 3 | ||||||||
| Address2: | CREDENTIALING MANAGER | ||||||||
| City: | WARWICK | ||||||||
| State: | NY | ||||||||
| PostalCode: | 109901035 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 8459873906 | ||||||||
| FaxNumber: | 8459875979 | ||||||||
| Practice Location | |||||||||
| Address1: | 70 HATFIELD LN STE 101 | ||||||||
| Address2: | |||||||||
| City: | GOSHEN | ||||||||
| State: | NY | ||||||||
| PostalCode: | 109246735 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 8453688808 | ||||||||
| FaxNumber: | 8453570709 | ||||||||
| Other Information | |||||||||
| ProviderEnumerationDate: | 12/15/2006 | ||||||||
| LastUpdateDate: | 06/15/2015 | ||||||||
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| ProviderGenderCode: | M | ||||||||
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| IsSoleProprietor: | N | ||||||||
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Taxonomy Information
| Taxonomy | License | State | Switch | TaxonomyGroup | TaxonomyType | TaxonomyClass | SubSpecialty | 2084N0400X | 202863-1 | NY | Y | Allopathic & Osteopathic Physicians | Psychiatry & Neurology | Neurology |
ID Information
| ID | Type | State | Issuer | Description | P1296864 | 01 | NY | OXFORD | OTHER | 393704 | 01 | NY | MVP | OTHER | 6624717 | 01 | NY | DEA | OTHER | 01955866-03 | 05 | NY | MEDICAID | 2175657 | 01 | NY | USHC | OTHER | 1000002206 | 01 | NY | AFFINITY | OTHER | 0000000046163 | 01 | NY | GHI HMO | OTHER | 240545 | 01 | NY | WELLCARE | OTHER |