Provider Demographics
NPI:1467607978
Name:NABULSI, OMAR HISHAM (MD)
Entity Type:Individual
Prefix:DR
First Name:OMAR
Middle Name:HISHAM
Last Name:NABULSI
Suffix:
Gender:M
Credentials:MD
Other - Prefix:
Other - First Name:
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Other - Last Name:
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Other - Credentials:
Mailing Address - Street 1:516 HAMBURG TPKE
Mailing Address - Street 2:SUITE 5
Mailing Address - City:WAYNE
Mailing Address - State:NJ
Mailing Address - Zip Code:07470-2062
Mailing Address - Country:US
Mailing Address - Phone:973-925-7770
Mailing Address - Fax:973-925-7772
Practice Address - Street 1:516 HAMBURG TPKE STE 5
Practice Address - Street 2:
Practice Address - City:WAYNE
Practice Address - State:NJ
Practice Address - Zip Code:07470-2063
Practice Address - Country:US
Practice Address - Phone:973-925-7770
Practice Address - Fax:973-925-7772
Is Sole Proprietor?:No
Enumeration Date:2008-11-25
Last Update Date:2017-12-13
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NJ25MA08768600207Q00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207Q00000XAllopathic & Osteopathic PhysiciansFamily Medicine