Active NPI
Obinna A Isiadinso, MD
- Internal Medicine Physician
- Poughkeepsie, NY
National Provider Identifier
1710002613
On this page
Key facts
NPPES NPI Registry- Primary specialty
- Internal Medicine Physician
- License
- 119153
- Practice address
- 19 Wood St
Poughkeepsie, NY 12603-4411 - Phone
- (845) 486-1069
- NPI assigned
- Mar 20, 2007
- Sex
- Male
- Sole proprietor
- Yes
NPPES NPI Registry
Registry information is reported by the provider to CMS and is not verified. About this source
Specialties & licenses 1
| Specialty (taxonomy) | Code | License | State | Primary |
|---|---|---|---|---|
| Internal Medicine Physician | 207R00000X | 119153 | NY | Primary |
Addresses
Primary practice location
19 Wood St
Poughkeepsie, NY 12603-4411
Mailing address
19 Wood St
Poughkeepsie, NY 12603-4411
Phone (845) 486-1069
Other identifiers 3
| Identifier | Type | State | Issuer |
|---|---|---|---|
| 119153 | Medicaid | NY | |
| 34D832 | Other | NY | MEDICARE PROVIDER # 34D832 |
| 012953301137361 | Medicaid | NY |
Other names 1
- Dr. Obinna A. Isiadinso
Medicare participation
Medicare enrollment files- Medicare fee-for-service enrollment
- Not listed in the public Medicare enrollment file
- Eligible to order & refer
- Part B services: No
- Medical equipment: Yes
- Home health: No
- Power mobility devices: Yes
- Hospice: No
National Provider Directory
National Provider Directory- Medicare enrollment (NPD)
- Enrolled
- Credentials
- Doctor of Medicine
State licenses
| License | State | Type | Specialty |
|---|---|---|---|
| 119153 | NY | MD | Internal Medicine Physician |
NPI Registry JSON
The complete NPPES record for this NPI in the NPI Registry API format.
{
"created_epoch": "1174348800000",
"enumeration_type": "NPI-1",
"last_updated_epoch": "1460419200000",
"number": "1710002613",
"addresses": [
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "MAILING",
"address_type": "DOM",
"address_1": "19 WOOD ST",
"city": "POUGHKEEPSIE",
"state": "NY",
"postal_code": "126034411",
"telephone_number": "845-486-1069"
},
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "LOCATION",
"address_type": "DOM",
"address_1": "19 WOOD ST",
"city": "POUGHKEEPSIE",
"state": "NY",
"postal_code": "126034411",
"telephone_number": "845-486-1069"
}
],
"practiceLocations": [],
"basic": {
"last_name": "ISIADINSO",
"first_name": "OBINNA",
"middle_name": "A",
"credential": "MD",
"sole_proprietor": "YES",
"sex": "M",
"enumeration_date": "2007-03-20",
"last_updated": "2016-04-12",
"status": "A"
},
"taxonomies": [
{
"code": "207R00000X",
"taxonomy_group": "",
"desc": "Internal Medicine",
"state": "NY",
"license": "119153",
"primary": true
}
],
"identifiers": [
{
"code": "05",
"desc": "MEDICAID",
"issuer": null,
"identifier": "119153",
"state": "NY"
},
{
"code": "01",
"desc": "Other (non-Medicare)",
"issuer": "MEDICARE PROVIDER # 34D832",
"identifier": "34D832",
"state": "NY"
},
{
"code": "05",
"desc": "MEDICAID",
"issuer": null,
"identifier": "012953301137361",
"state": "NY"
}
],
"endpoints": [],
"other_names": [
{
"first_name": "OBINNA",
"last_name": "ISIADINSO",
"middle_name": "A.",
"prefix": "DR.",
"credential": "MD., PHD.",
"code": "2",
"type": "Professional Name"
}
]
}Other providers in Poughkeepsie, NY
Sources for this page
- NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Apr 12, 2016; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
- Medicare enrollment (CMS PECOS): enrollments, PAC IDs and benefit reassignments; Order and Referring.
- National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.