Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
N | 208000000X | Pediatrician | 002564 | NY |
N | 2080P0203X | Pediatric Critical Care Doctor | 002564 | NY |
Y | 2080P0204X | Pediatric Emergency Doctor | 002564 | NY |
NPI | 1053324913 |
---|---|
Provider Name | Omar S Alibrahim |
First Address | Amherst, NY 14226-3822 |
Second Address | Buffalo, NY 14222-2006 |
Gender | M |
NPI Entity type | Individual |
Is Sole Proprietor | No |
Is Organization Subpart | N/A |
Enumeration Date | 14/08/2006 |
Last Update Date | 17/08/2021 |
IDENTIFIER | TYPE / CODE | IDENTIFIER STATE |
---|---|---|
00027712401 | UNIVERA (01) | |
000930689001 | BC/BS (01) | |
000930689002 | BC/BS (01) | |
02806462 | (05) | NY |
061007000015 | FIDELIS (01) | |
1213990 | IHA (01) | |
I70459 | (02) |