Healthcare Provider Details

I. General information

NPI: 1962277194
Provider Name (Legal Business Name): OMNI MEDICAL OF NJ PC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 11/17/2023
Last Update Date: 03/20/2024
Certification Date: 03/07/2024
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1009 79TH ST STE 1
NORTH BERGEN NJ
07047-4981
US

IV. Provider business mailing address

1009 79TH ST STE 1
NORTH BERGEN NJ
07047-4981
US

V. Phone/Fax

Practice location:
  • Phone: 212-319-3977
  • Fax: 212-721-0806
Mailing address:
  • Phone: 212-319-3977
  • Fax: 212-721-0806

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code207RI0011X
TaxonomyInterventional Cardiology Physician
License Number
License Number State
# 2
Primary TaxonomyN
Taxonomy Code2085R0204X
TaxonomyVascular & Interventional Radiology Physician
License Number
License Number State
# 3
Primary TaxonomyN
Taxonomy Code208VP0014X
TaxonomyInterventional Pain Medicine Physician
License Number
License Number State

VIII. Authorized Official

Name: ALI ABOUFARES
Title or Position: PRESIDENT
Credential: MD
Phone: 212-319-3977