Provider Demographics
NPI:1225449440
Name:OMID NIKROUZ MD PC
Entity Type:Organization
Organization Name:OMID NIKROUZ MD PC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:
Authorized Official - First Name:OMID
Authorized Official - Middle Name:
Authorized Official - Last Name:NIKROUZ
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:201-927-3825
Mailing Address - Street 1:390 BURNET PLACE
Mailing Address - Street 2:
Mailing Address - City:PARAMUS
Mailing Address - State:NJ
Mailing Address - Zip Code:07652
Mailing Address - Country:US
Mailing Address - Phone:
Mailing Address - Fax:
Practice Address - Street 1:19 EAST 80TH ST
Practice Address - Street 2:1E
Practice Address - City:NEW YORK
Practice Address - State:NY
Practice Address - Zip Code:11075
Practice Address - Country:US
Practice Address - Phone:201-927-9825
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2014-05-09
Last Update Date:2014-05-09
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes261QM1300XAmbulatory Health Care FacilitiesClinic/CenterMulti-Specialty