Provider Demographics
NPI:1952403529
Name:BAKSH, OMERKIAM (DC)
Entity Type:Individual
Prefix:
First Name:OMERKIAM
Middle Name:
Last Name:BAKSH
Suffix:
Gender:M
Credentials:DC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:679 MONTGOMERY ST
Mailing Address - Street 2:
Mailing Address - City:JERSEY CITY
Mailing Address - State:NJ
Mailing Address - Zip Code:07306-3324
Mailing Address - Country:US
Mailing Address - Phone:201-433-7760
Mailing Address - Fax:201-433-8010
Practice Address - Street 1:679 MONTGOMERY ST
Practice Address - Street 2:
Practice Address - City:JERSEY CITY
Practice Address - State:NJ
Practice Address - Zip Code:07306-3324
Practice Address - Country:US
Practice Address - Phone:201-433-7760
Practice Address - Fax:201-433-8010
Is Sole Proprietor?:Yes
Enumeration Date:2006-09-02
Last Update Date:2008-06-26
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NJ38MC00625000111N00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes111N00000XChiropractic ProvidersChiropractor
Provider Identifiers
StateIdentifier IDID TypeIssuer
NJ0060071Medicaid
NJV03678Medicare UPIN
NJ087872YCHMedicare PIN