Provider Demographics
NPI:1356912554
Name:HAJI, ABBAS OMAR
Entity type:Individual
Prefix:
First Name:ABBAS
Middle Name:OMAR
Last Name:HAJI
Suffix:
Gender:M
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:906 PEPPERCORN PL
Mailing Address - Street 2:
Mailing Address - City:COLUMBUS
Mailing Address - State:OH
Mailing Address - Zip Code:43230-5069
Mailing Address - Country:US
Mailing Address - Phone:614-680-5876
Mailing Address - Fax:
Practice Address - Street 1:50 KINGSTON AVE
Practice Address - Street 2:
Practice Address - City:COLUMBUS
Practice Address - State:OH
Practice Address - Zip Code:43207-2436
Practice Address - Country:US
Practice Address - Phone:614-680-5876
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2021-07-08
Last Update Date:2021-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OH374U00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes374U00000XNursing Service Related ProvidersHome Health Aide