Provider Demographics
NPI:1811935323
Name:ABDUL-RAHMAN, OMAR ALI SR (MD)
Entity type:Individual
Prefix:DR
First Name:OMAR
Middle Name:ALI
Last Name:ABDUL-RAHMAN
Suffix:SR
Gender:M
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:505 E 70TH ST FL 3
Mailing Address - Street 2:
Mailing Address - City:NEW YORK
Mailing Address - State:NY
Mailing Address - Zip Code:10021-4872
Mailing Address - Country:US
Mailing Address - Phone:466-962-2205
Mailing Address - Fax:466-962-0273
Practice Address - Street 1:505 E 70TH ST FL 3
Practice Address - Street 2:
Practice Address - City:NEW YORK
Practice Address - State:NY
Practice Address - Zip Code:10021-4872
Practice Address - Country:US
Practice Address - Phone:646-962-2205
Practice Address - Fax:646-962-0273
Is Sole Proprietor?:Yes
Enumeration Date:2006-06-04
Last Update Date:2023-05-18
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MS17448207SG0201X
NE30159207SG0201X
NY321107207SG0201X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207SG0201XAllopathic & Osteopathic PhysiciansMedical GeneticsClinical Genetics (M.D.)
Provider Identifiers
StateIdentifier IDID TypeIssuer
NE30159OtherMEDICAL LICENSE
MS302I377217Medicare PIN
MS302I847225Medicare PIN
MS512I370004Medicare PIN
MSI33977Medicare UPIN