Provider Demographics
NPI:1558595645
Name:THE OMNI CENTER
Entity Type:Organization
Organization Name:THE OMNI CENTER
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:DIRECTOR
Authorized Official - Prefix:DR
Authorized Official - First Name:CAROL
Authorized Official - Middle Name:B
Authorized Official - Last Name:LETZTER
Authorized Official - Suffix:
Authorized Official - Credentials:AUD
Authorized Official - Phone:718-641-3817
Mailing Address - Street 1:16124 84TH ST
Mailing Address - Street 2:
Mailing Address - City:HOWARD BEACH
Mailing Address - State:NY
Mailing Address - Zip Code:11414-3315
Mailing Address - Country:US
Mailing Address - Phone:718-641-3817
Mailing Address - Fax:718-641-7582
Practice Address - Street 1:16124 84TH ST
Practice Address - Street 2:
Practice Address - City:HOWARD BEACH
Practice Address - State:NY
Practice Address - Zip Code:11414-3315
Practice Address - Country:US
Practice Address - Phone:718-641-3817
Practice Address - Fax:718-641-7582
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2009-05-05
Last Update Date:2009-05-05
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY3071252Y00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes252Y00000XAgenciesEarly Intervention Provider Agency
Provider Identifiers
StateIdentifier IDID TypeIssuer
NYR28215Medicare UPIN