Provider Demographics
NPI:1467999201
Name:ALI MAHOMED OMAR PHYSICIAN, PC
Entity Type:Organization
Organization Name:ALI MAHOMED OMAR PHYSICIAN, PC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PHYSICIAN
Authorized Official - Prefix:
Authorized Official - First Name:ALI
Authorized Official - Middle Name:M
Authorized Official - Last Name:OMAR
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:914-837-1655
Mailing Address - Street 1:5 RENAISSANCE SQ PH 2E
Mailing Address - Street 2:
Mailing Address - City:WHITE PLAINS
Mailing Address - State:NY
Mailing Address - Zip Code:10601-3042
Mailing Address - Country:US
Mailing Address - Phone:914-837-1655
Mailing Address - Fax:
Practice Address - Street 1:5 RENAISSANCE SQ PH 2E
Practice Address - Street 2:
Practice Address - City:WHITE PLAINS
Practice Address - State:NY
Practice Address - Zip Code:10601-3042
Practice Address - Country:US
Practice Address - Phone:914-837-1655
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2017-01-31
Last Update Date:2017-01-31
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY125210207R00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes207R00000XAllopathic & Osteopathic PhysiciansInternal MedicineGroup - Single Specialty