Provider Demographics
NPI:1841036811
Name:HOLMAN, OMAR
Entity type:Individual
Prefix:
First Name:OMAR
Middle Name:
Last Name:HOLMAN
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 1:1876 MANOR DR APT D
Mailing Address - Street 2:
Mailing Address - City:UNION
Mailing Address - State:NJ
Mailing Address - Zip Code:07083-4563
Mailing Address - Country:US
Mailing Address - Phone:862-754-5549
Mailing Address - Fax:
Practice Address - Street 1:1876 MANOR DR APT D
Practice Address - Street 2:
Practice Address - City:UNION
Practice Address - State:NJ
Practice Address - Zip Code:07083-4563
Practice Address - Country:US
Practice Address - Phone:862-754-5549
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2024-07-08
Last Update Date:2024-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NJH62846057908755343900000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes343900000XTransportation ServicesNon-emergency Medical Transport (VAN)