Provider Demographics
NPI:1255647426
Name:OMRAN, OSAMA E (PT, MS DPT)
Entity type:Individual
Prefix:DR
First Name:OSAMA
Middle Name:E
Last Name:OMRAN
Suffix:
Gender:M
Credentials:PT, MS DPT
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:684 OCEAN TER
Mailing Address - Street 2:
Mailing Address - City:STATEN ISLAND
Mailing Address - State:NY
Mailing Address - Zip Code:10301-4538
Mailing Address - Country:US
Mailing Address - Phone:646-996-7095
Mailing Address - Fax:800-722-4260
Practice Address - Street 1:684 OCEAN TER
Practice Address - Street 2:
Practice Address - City:STATEN ISLAND
Practice Address - State:NY
Practice Address - Zip Code:10301-4538
Practice Address - Country:US
Practice Address - Phone:646-996-7095
Practice Address - Fax:800-722-4260
Is Sole Proprietor?:Yes
Enumeration Date:2010-08-26
Last Update Date:2010-08-26
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY017100-1225100000X, 2251E1300X, 2251N0400X, 2251P0200X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes2251P0200XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical TherapistPediatrics
No225100000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical Therapist
No2251E1300XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical TherapistElectrophysiology, Clinical
No2251N0400XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical TherapistNeurology