Provider Demographics
NPI:1043555295
Name:KAMEL, OMAIMA MOHAMED (PT)
Entity Type:Individual
Prefix:
First Name:OMAIMA
Middle Name:MOHAMED
Last Name:KAMEL
Suffix:
Gender:F
Credentials:PT
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:613 STEUBEN ST
Mailing Address - Street 2:
Mailing Address - City:STATEN ISLAND
Mailing Address - State:NY
Mailing Address - Zip Code:10305-2605
Mailing Address - Country:US
Mailing Address - Phone:917-573-4312
Mailing Address - Fax:718-447-6586
Practice Address - Street 1:613 STEUBEN ST
Practice Address - Street 2:
Practice Address - City:STATEN ISLAND
Practice Address - State:NY
Practice Address - Zip Code:10305-2605
Practice Address - Country:US
Practice Address - Phone:917-573-4312
Practice Address - Fax:718-447-6586
Is Sole Proprietor?:Yes
Enumeration Date:2012-11-28
Last Update Date:2012-11-28
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY026996225100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225100000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical Therapist