Provider Demographics
NPI:1679756159
Name:OOMMEN, ANNIE (MD)
Entity Type:Individual
Prefix:DR
First Name:ANNIE
Middle Name:
Last Name:OOMMEN
Suffix:
Gender:F
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:73 MARKET ST
Mailing Address - Street 2:SUITE 214
Mailing Address - City:YONKERS
Mailing Address - State:NY
Mailing Address - Zip Code:10710-7602
Mailing Address - Country:US
Mailing Address - Phone:914-848-8960
Mailing Address - Fax:
Practice Address - Street 1:73 MARKET ST
Practice Address - Street 2:SUITE 214
Practice Address - City:YONKERS
Practice Address - State:NY
Practice Address - Zip Code:10710-7602
Practice Address - Country:US
Practice Address - Phone:914-848-8960
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2007-12-07
Last Update Date:2013-10-16
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY263265208600000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes208600000XAllopathic & Osteopathic PhysiciansSurgery