Provider Demographics
NPI:1346273885
Name:OMIATEK, DEBRA M (MD)
Entity Type:Individual
Prefix:DR
First Name:DEBRA
Middle Name:M
Last Name:OMIATEK
Suffix:
Gender:F
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:265 PORTAGE RD
Mailing Address - Street 2:
Mailing Address - City:LEWISTON
Mailing Address - State:NY
Mailing Address - Zip Code:14092-1710
Mailing Address - Country:US
Mailing Address - Phone:716-754-4419
Mailing Address - Fax:
Practice Address - Street 1:265 PORTAGE RD
Practice Address - Street 2:
Practice Address - City:LEWISTON
Practice Address - State:NY
Practice Address - Zip Code:14092-1710
Practice Address - Country:US
Practice Address - Phone:716-754-4419
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2006-07-08
Last Update Date:2013-05-09
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY188148-1207Q00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207Q00000XAllopathic & Osteopathic PhysiciansFamily Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
NY01609925Medicaid
NY013057BMedicare ID - Type Unspecified
NY01609925Medicaid