Provider Demographics
NPI:1164418166
Name:HAKIMIAN, OMID (MD)
Entity Type:Individual
Prefix:DR
First Name:OMID
Middle Name:
Last Name:HAKIMIAN
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 1:75-54 METROPOLITAN AVENUE
Mailing Address - Street 2:2ND FLOOR
Mailing Address - City:MIDDLE VILLAGE
Mailing Address - State:NY
Mailing Address - Zip Code:11379
Mailing Address - Country:US
Mailing Address - Phone:718-769-5158
Mailing Address - Fax:718-646-4087
Practice Address - Street 1:75-54 METROPOLITAN AVENUE
Practice Address - Street 2:2ND FLOOR
Practice Address - City:MIDDLE VILLAGE
Practice Address - State:NY
Practice Address - Zip Code:11379
Practice Address - Country:US
Practice Address - Phone:718-894-4200
Practice Address - Fax:718-416-4471
Is Sole Proprietor?:No
Enumeration Date:2005-09-25
Last Update Date:2015-02-19
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY207562-1208800000X
NY207562208800000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes208800000XAllopathic & Osteopathic PhysiciansUrology
Provider Identifiers
StateIdentifier IDID TypeIssuer
NY02164730Medicaid
NY207562OtherLICENSE #
NY3S3641Medicare PIN
NY207562OtherLICENSE #