Provider Demographics
NPI:1619984051
Name:O'BRIEN, JANET (R PA)
Entity type:Individual
Prefix:MRS
First Name:JANET
Middle Name:
Last Name:O'BRIEN
Suffix:
Gender:F
Credentials:R PA
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:30 HATFIELD LANE SUITE 105
Mailing Address - Street 2:DIAMOND INSTITUE
Mailing Address - City:GOSHEN
Mailing Address - State:NY
Mailing Address - Zip Code:10924
Mailing Address - Country:US
Mailing Address - Phone:845-291-1111
Mailing Address - Fax:845-291-1103
Practice Address - Street 1:30 HATFIELD LANE SUITE 105
Practice Address - Street 2:DIAMOND INSTITUE
Practice Address - City:GOSHEN
Practice Address - State:NY
Practice Address - Zip Code:10924
Practice Address - Country:US
Practice Address - Phone:845-291-1111
Practice Address - Fax:845-291-1103
Is Sole Proprietor?:No
Enumeration Date:2006-08-01
Last Update Date:2011-02-04
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
07462471S1302X
NY011101-1363A00000X, 363AM0700X
NJ25MP00157600363A00000X, 363AM0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363AM0700XPhysician Assistants & Advanced Practice Nursing ProvidersPhysician AssistantMedical
No2471S1302XTechnologists, Technicians & Other Technical Service ProvidersRadiologic TechnologistSonography
No363A00000XPhysician Assistants & Advanced Practice Nursing ProvidersPhysician Assistant