Provider Demographics
NPI:1629653563
Name:OMEGA PHYSICIANS LLC
Entity Type:Organization
Organization Name:OMEGA PHYSICIANS LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:
Authorized Official - First Name:NAGASASIKANTH
Authorized Official - Middle Name:R
Authorized Official - Last Name:MOPURI
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:404-702-0995
Mailing Address - Street 1:1122 53RD ST APT 507
Mailing Address - Street 2:
Mailing Address - City:NORTH BERGEN
Mailing Address - State:NJ
Mailing Address - Zip Code:07047-3158
Mailing Address - Country:US
Mailing Address - Phone:240-408-6889
Mailing Address - Fax:
Practice Address - Street 1:493 BLACK OAK RIDGE RD
Practice Address - Street 2:
Practice Address - City:WAYNE
Practice Address - State:NJ
Practice Address - Zip Code:07470-6501
Practice Address - Country:US
Practice Address - Phone:404-702-0995
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2021-03-12
Last Update Date:2024-02-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes207R00000XAllopathic & Osteopathic PhysiciansInternal MedicineGroup - Single Specialty