Provider Demographics
NPI:1821284043
Name:GEORGE, OMANA (LPN)
Entity Type:Individual
Prefix:MRS
First Name:OMANA
Middle Name:
Last Name:GEORGE
Suffix:
Gender:F
Credentials:LPN
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:700 FULTON ST
Mailing Address - Street 2:APT-D3
Mailing Address - City:FARMINGDALE
Mailing Address - State:NY
Mailing Address - Zip Code:11735-3459
Mailing Address - Country:US
Mailing Address - Phone:516-293-2442
Mailing Address - Fax:
Practice Address - Street 1:87 FERNWOOD TER
Practice Address - Street 2:
Practice Address - City:STEWART MANOR
Practice Address - State:NY
Practice Address - Zip Code:11530-3811
Practice Address - Country:US
Practice Address - Phone:516-358-0152
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2007-09-20
Last Update Date:2007-09-20
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY238207-1164W00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes164W00000XNursing Service ProvidersLicensed Practical Nurse
Provider Identifiers
StateIdentifier IDID TypeIssuer
NY01923399Medicaid