Healthcare Provider Details

I. General information

NPI: 1457278509
Provider Name (Legal Business Name): OMNI VERGE TECHNOLOGIES LLC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 06/30/2026
Last Update Date: 07/02/2026
Certification Date: 07/02/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

24 S ADDISON ST APT 803
BENSENVILLE IL
60106-2195
US

IV. Provider business mailing address

24 S ADDISON ST APT 803
BENSENVILLE IL
60106-2195
US

V. Phone/Fax

Practice location:
  • Phone: 90-461-8629
  • Fax:
Mailing address:
  • Phone: 904-618-6290
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code332B00000X
TaxonomyDurable Medical Equipment & Medical Supplies
License Number
License Number State

VIII. Authorized Official

Name: QASIM ALI SIDDIQUI
Title or Position: OWNER
Credential:
Phone: 904-618-6290