Provider Demographics
NPI:1932148327
Name:TAMIMI, OMAR A (MD)
Entity Type:Individual
Prefix:DR
First Name:OMAR
Middle Name:A
Last Name:TAMIMI
Suffix:
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 1:488 EAGLE POINT DR
Mailing Address - Street 2:
Mailing Address - City:TOMS RIVER
Mailing Address - State:NJ
Mailing Address - Zip Code:08753-3306
Mailing Address - Country:US
Mailing Address - Phone:732-349-4422
Mailing Address - Fax:732-349-8126
Practice Address - Street 1:477 LAKEHURST RD
Practice Address - Street 2:
Practice Address - City:TOMS RIVER
Practice Address - State:NJ
Practice Address - Zip Code:08755-6342
Practice Address - Country:US
Practice Address - Phone:732-349-4422
Practice Address - Fax:732-349-8126
Is Sole Proprietor?:Not Answered
Enumeration Date:2006-06-04
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NJ25MA05507500207RG0100X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207RG0100XAllopathic & Osteopathic PhysiciansInternal MedicineGastroenterology
Provider Identifiers
StateIdentifier IDID TypeIssuer
NJ5183502Medicaid
F29458Medicare UPIN
NJTA724714Medicare ID - Type Unspecified