Healthcare Provider Details

I. General information

NPI: 1316236383
Provider Name (Legal Business Name): ALI AHMAD ALI AL-OMARI MD
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 03/30/2011
Last Update Date: 04/24/2024
Certification Date: 04/24/2024
Deactivation Date:
Reactivation Date:

III. Provider practice location address

385 TREMONT AVE
EAST ORANGE NJ
07018-1023
US

IV. Provider business mailing address

300 RIVERFRONT BLVD APT 2302
ELMWOOD PARK NJ
07407-1673
US

V. Phone/Fax

Practice location:
  • Phone: 627-866-1621
  • Fax:
Mailing address:
  • Phone: 617-866-1621
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code207XS0114X
TaxonomyAdult Reconstructive Orthopaedic Surgery Physician
License Number280194
License Number StateNY
# 2
Primary TaxonomyN
Taxonomy Code207XS0117X
TaxonomyOrthopaedic Surgery of the Spine Physician
License Number280194
License Number StateNY
# 3
Primary TaxonomyN
Taxonomy Code207XX0801X
TaxonomyOrthopaedic Trauma Physician
License Number280194
License Number StateNY
# 4
Primary TaxonomyY
Taxonomy Code207X00000X
TaxonomyOrthopaedic Surgery Physician
License Number280194
License Number StateNY
# 5
Primary TaxonomyN
Taxonomy Code207XP3100X
TaxonomyPediatric Orthopaedic Surgery Physician
License Number280194
License Number StateNY

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: