Provider Demographics
NPI:1295010239
Name:OMEGA HEALTH AND WELLNESS LLC
Entity Type:Organization
Organization Name:OMEGA HEALTH AND WELLNESS LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:VICE PRESIDENT
Authorized Official - Prefix:
Authorized Official - First Name:ROSEMARIE
Authorized Official - Middle Name:
Authorized Official - Last Name:MCGIVERON
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:716-648-5500
Mailing Address - Street 1:5893 CAMP RD
Mailing Address - Street 2:SUITE 9
Mailing Address - City:HAMBURG
Mailing Address - State:NY
Mailing Address - Zip Code:14075-4470
Mailing Address - Country:US
Mailing Address - Phone:716-648-5500
Mailing Address - Fax:716-648-7196
Practice Address - Street 1:5893 CAMP RD
Practice Address - Street 2:SUITE 9
Practice Address - City:HAMBURG
Practice Address - State:NY
Practice Address - Zip Code:14075-4470
Practice Address - Country:US
Practice Address - Phone:716-648-5500
Practice Address - Fax:716-648-7196
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2011-10-20
Last Update Date:2011-10-20
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NYF381390-1363LP0200X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes363LP0200XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerPediatricsGroup - Single Specialty