MEDICARE: DR. OMID ROFEIM MD

Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

#	Taxonomy Code	Taxonomy	License Number	License Number State
1	208800000X	Urology Physician	210903	NY

General Provider Information

NPI Number	:	1144275173
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	DR. OMID ROFEIM MD

Provider Business Mailing Address
First Line	:	233 7TH ST
Second Line	:	SUITE 203
City	:	GARDEN CITY
State	:	NY
Zip	:	11530-5747
Country	:	US
Telephone Number	:	516-294-7666
Fax Number	:	516-294-7672

Provider Business Practice Location Address
First Line	:	233 7TH ST
Second Line	:	SUITE 203
City	:	GARDEN CITY
State	:	NY
Zip	:	11530-5747
Country	:	US
Telephone Number	:	516-294-7666
Fax Number	:	516-294-7672

Authorized Official
Title or Position	:
Name	:
Credential	:
Telephone Number	:

Provider Enumeration Date	:	05/25/2006
Last Update Date	:	01/03/2013

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