Provider Demographics
NPI:1477578607
Name:TORRES LOZADA, OMAR (MD)
Entity Type:Individual
Prefix:
First Name:OMAR
Middle Name:
Last Name:TORRES LOZADA
Suffix:
Gender:M
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:182 SOUTH ST
Mailing Address - Street 2:SUITE 1
Mailing Address - City:MORRISTOWN
Mailing Address - State:NJ
Mailing Address - Zip Code:07960-5377
Mailing Address - Country:US
Mailing Address - Phone:973-267-0300
Mailing Address - Fax:973-539-5401
Practice Address - Street 1:117 E 18TH ST FRNT 1
Practice Address - Street 2:
Practice Address - City:NEW YORK
Practice Address - State:NY
Practice Address - Zip Code:10003-2113
Practice Address - Country:US
Practice Address - Phone:129-775-6712
Practice Address - Fax:212-677-5802
Is Sole Proprietor?:No
Enumeration Date:2006-07-12
Last Update Date:2019-09-05
Deactivation Date:
Deactivation Code:
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Provider Licenses
StateLicense IDTaxonomies
PR13888207N00000X, 207ND0101X
NY225487207N00000X, 207ND0101X, 174400000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes174400000XOther Service ProvidersSpecialist
No207N00000XAllopathic & Osteopathic PhysiciansDermatology
No207ND0101XAllopathic & Osteopathic PhysiciansDermatologyMOHS-Micrographic Surgery
Provider Identifiers
StateIdentifier IDID TypeIssuer
NYH85406Medicare UPIN
NJ238336BV6Medicare PIN