Healthcare Provider Details

I. General information

NPI: 1982530622
Provider Name (Legal Business Name): SUZETTE OMANE
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 06/22/2026
Last Update Date: 06/22/2026
Certification Date: 06/21/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

350 BOULEVARD
PASSAIC NJ
07055-2840
US

IV. Provider business mailing address

2107 CANARSIE RD
BROOKLYN NY
11236-5419
US

V. Phone/Fax

Practice location:
  • Phone: 347-447-1098
  • Fax:
Mailing address:
  • Phone: 347-447-1098
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code390200000X
TaxonomyStudent in an Organized Health Care Education/Training Program
License Number
License Number StateNJ

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: