Healthcare Provider Details

I. General information

NPI: 1306356019
Provider Name (Legal Business Name): OMEK LLC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 10/08/2017
Last Update Date: 05/22/2019
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

705 CROSS ST STE 153
LAKEWOOD NJ
08701-4029
US

IV. Provider business mailing address

705 CROSS ST STE 153
LAKEWOOD NJ
08701-4029
US

V. Phone/Fax

Practice location:
  • Phone: 732-930-1255
  • Fax:
Mailing address:
  • Phone: 732-930-1255
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code225100000X
TaxonomyPhysical Therapist
License Number
License Number State
# 2
Primary TaxonomyN
Taxonomy Code225X00000X
TaxonomyOccupational Therapist
License Number
License Number State
# 3
Primary TaxonomyN
Taxonomy Code235Z00000X
TaxonomySpeech-Language Pathologist
License Number
License Number State
# 4
Primary TaxonomyY
Taxonomy Code103K00000X
TaxonomyBehavior Analyst
License Number
License Number State

VIII. Authorized Official

Name: MRS. CHAYA FURST
Title or Position: DIRECTOR
Credential:
Phone: 732-930-1255