Provider Demographics
NPI:1912946088
Name:OMAR, HUSSEIN (PHYSICIAN, PC)
Entity Type:Individual
Prefix:DR
First Name:HUSSEIN
Middle Name:
Last Name:OMAR
Suffix:
Gender:M
Credentials:PHYSICIAN, PC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:PO BOX 558
Mailing Address - Street 2:
Mailing Address - City:FERNDALE
Mailing Address - State:NY
Mailing Address - Zip Code:12734-0558
Mailing Address - Country:US
Mailing Address - Phone:845-292-0078
Mailing Address - Fax:845-292-3244
Practice Address - Street 1:1885 STATE ROUTE 52
Practice Address - Street 2:
Practice Address - City:LIBERTY
Practice Address - State:NY
Practice Address - Zip Code:12754-8309
Practice Address - Country:US
Practice Address - Phone:845-292-0078
Practice Address - Fax:845-292-3244
Is Sole Proprietor?:Yes
Enumeration Date:2006-06-05
Last Update Date:2011-02-16
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY154839208VP0014X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes208VP0014XAllopathic & Osteopathic PhysiciansPain MedicineInterventional Pain Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
1912946088OtherNPI