Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
Y | 207RN0300X | Nephrologist | 00000000000000 | NY |
NPI | 1023539590 |
---|---|
Provider Name | Ismail Omran |
First Address | Elmhurst, NY 11373-1329 |
Second Address | Elmhurst, NY 11373-1329 |
Gender | M |
NPI Entity type | Individual |
Is Sole Proprietor | No |
Is Organization Subpart | N/A |
Enumeration Date | 05/07/2017 |
Last Update Date | 16/06/2018 |