Provider Demographics
NPI:1043490071
Name:BOBAL, JAMES MATTHEW (RPH)
Entity type:Individual
Prefix:
First Name:JAMES
Middle Name:MATTHEW
Last Name:BOBAL
Suffix:
Gender:M
Credentials:RPH
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:3701 VESTAL PKWY E
Mailing Address - Street 2:
Mailing Address - City:VESTAL
Mailing Address - State:NY
Mailing Address - Zip Code:13850-2397
Mailing Address - Country:US
Mailing Address - Phone:607-729-9141
Mailing Address - Fax:607-729-4680
Practice Address - Street 1:3701 VESTAL PKWY E
Practice Address - Street 2:
Practice Address - City:VESTAL
Practice Address - State:NY
Practice Address - Zip Code:13850-2397
Practice Address - Country:US
Practice Address - Phone:607-729-9141
Practice Address - Fax:607-729-4680
Is Sole Proprietor?:No
Enumeration Date:2007-11-07
Last Update Date:2007-11-07
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY039042183500000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes183500000XPharmacy Service ProvidersPharmacist
Provider Identifiers
StateIdentifier IDID TypeIssuer
NY00483629Medicaid