Provider Demographics
NPI:1861640476
Name:OMRAN, AHMED (PT)
Entity Type:Individual
Prefix:
First Name:AHMED
Middle Name:
Last Name:OMRAN
Suffix:
Gender:M
Credentials:PT
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:2017 65TH ST
Mailing Address - Street 2:2ND. FL.
Mailing Address - City:BROOKLYN
Mailing Address - State:NY
Mailing Address - Zip Code:11204-3927
Mailing Address - Country:US
Mailing Address - Phone:917-535-7062
Mailing Address - Fax:718-234-7062
Practice Address - Street 1:2017 65TH ST
Practice Address - Street 2:2ND. FL.
Practice Address - City:BROOKLYN
Practice Address - State:NY
Practice Address - Zip Code:11204-3927
Practice Address - Country:US
Practice Address - Phone:917-535-7062
Practice Address - Fax:718-234-7062
Is Sole Proprietor?:Yes
Enumeration Date:2008-09-08
Last Update Date:2008-09-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY021049174400000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes174400000XOther Service ProvidersSpecialist