Provider Demographics
NPI:1659329050
Name:HUSSEIN OMAR, PHYSICIAN, P.C.
Entity Type:Organization
Organization Name:HUSSEIN OMAR, PHYSICIAN, P.C.
Other - Org Name:PAIN CONTROL CENTER
Other - Org Type:Doing Business As
Authorized Official - Title/Position:PRESIDENT
Authorized Official - Prefix:DR
Authorized Official - First Name:HUSSEIN
Authorized Official - Middle Name:
Authorized Official - Last Name:OMAR
Authorized Official - Suffix:
Authorized Official - Credentials:PHYSICIAN, PC
Authorized Official - Phone:845-292-0078
Mailing Address - Street 1:PO BOX 558
Mailing Address - Street 2:
Mailing Address - City:FERNDALE
Mailing Address - State:NY
Mailing Address - Zip Code:12734-0558
Mailing Address - Country:US
Mailing Address - Phone:845-292-0078
Mailing Address - Fax:845-292-3244
Practice Address - Street 1:1885 STATE ROUTE 52
Practice Address - Street 2:
Practice Address - City:LIBERTY
Practice Address - State:NY
Practice Address - Zip Code:12754-8309
Practice Address - Country:US
Practice Address - Phone:845-292-0078
Practice Address - Fax:845-292-3244
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-05-05
Last Update Date:2015-03-10
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY154839174400000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes174400000XOther Service ProvidersSpecialistGroup - Multi-Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
NY01624684Medicaid
NY110306800OtherUS DEPT OF LABOR
NY5829053OtherAETNA
NY01624684Medicaid