Provider Demographics
NPI:1982039145
Name:OMEDNYC
Entity Type:Organization
Organization Name:OMEDNYC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:
Authorized Official - First Name:YOKO
Authorized Official - Middle Name:
Authorized Official - Last Name:KUO
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:917-650-3883
Mailing Address - Street 1:26 67TH ST
Mailing Address - Street 2:
Mailing Address - City:WEST NEW YORK
Mailing Address - State:NJ
Mailing Address - Zip Code:07093-4308
Mailing Address - Country:US
Mailing Address - Phone:917-650-3883
Mailing Address - Fax:
Practice Address - Street 1:333 E 49TH ST
Practice Address - Street 2:LOBBY E
Practice Address - City:NEW YORK
Practice Address - State:NY
Practice Address - Zip Code:10017-1680
Practice Address - Country:US
Practice Address - Phone:917-650-3883
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2013-09-06
Last Update Date:2013-09-06
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY004069302F00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes302F00000XManaged Care OrganizationsExclusive Provider Organization