Basic Information
| Provider Information | |||||||||
| NPI: | 1912946088 | ||||||||
| EntityType: | 1 | ||||||||
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| OrganizationName: | |||||||||
| LastName: | OMAR | ||||||||
| FirstName: | HUSSEIN | ||||||||
| MiddleName: | |||||||||
| NamePrefix: | DR. | ||||||||
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| Credential: | PHYSICIAN, P.C. | ||||||||
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| Mailing Information | |||||||||
| Address1: | PO BOX 558 | ||||||||
| Address2: | |||||||||
| City: | FERNDALE | ||||||||
| State: | NY | ||||||||
| PostalCode: | 127340558 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 8452920078 | ||||||||
| FaxNumber: | 8452923244 | ||||||||
| Practice Location | |||||||||
| Address1: | 1885 STATE ROUTE 52 | ||||||||
| Address2: | |||||||||
| City: | LIBERTY | ||||||||
| State: | NY | ||||||||
| PostalCode: | 127548309 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 8452920078 | ||||||||
| FaxNumber: | 8452923244 | ||||||||
| Other Information | |||||||||
| ProviderEnumerationDate: | 06/05/2006 | ||||||||
| LastUpdateDate: | 02/16/2011 | ||||||||
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| ProviderGenderCode: | M | ||||||||
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| IsSoleProprietor: | Y | ||||||||
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Taxonomy Information
| Taxonomy | License | State | Switch | TaxonomyGroup | TaxonomyType | TaxonomyClass | SubSpecialty | 208VP0014X | 154839 | NY | Y | Allopathic & Osteopathic Physicians | Pain Medicine | Interventional Pain Medicine |
ID Information
| ID | Type | State | Issuer | Description | 1912946088 | 01 | NPI | OTHER |