Provider Demographics
NPI:1083760441
Name:BEY, OMAR M (MD)
Entity Type:Individual
Prefix:DR
First Name:OMAR
Middle Name:M
Last Name:BEY
Suffix:
Gender:M
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:231 MONTROSE AVE
Mailing Address - Street 2:
Mailing Address - City:SOUTH ORANGE
Mailing Address - State:NJ
Mailing Address - Zip Code:07079-2416
Mailing Address - Country:US
Mailing Address - Phone:973-926-6761
Mailing Address - Fax:973-923-5636
Practice Address - Street 1:2040 MILLBURN AVE
Practice Address - Street 2:403
Practice Address - City:MAPLEWOOD
Practice Address - State:NJ
Practice Address - Zip Code:07040-3726
Practice Address - Country:US
Practice Address - Phone:973-761-6761
Practice Address - Fax:973-761-6763
Is Sole Proprietor?:Yes
Enumeration Date:2007-01-26
Last Update Date:2014-12-03
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NJMA45212174400000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes174400000XOther Service ProvidersSpecialist
Provider Identifiers
StateIdentifier IDID TypeIssuer
NJ1087100Medicaid
NJ1087100Medicaid
NJ001936Medicare ID - Type Unspecified