Healthcare Provider Details

I. General information

NPI: 1730821430
Provider Name (Legal Business Name): JASMINE OMRAN MD
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 04/12/2022
Last Update Date: 10/09/2026
Certification Date: 10/09/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

121 DEKALB AVE HOUSE STAFF ADMINISTRATION
BROOKLYN NY
11201-5425
US

IV. Provider business mailing address

1 BROOKDALE PLZ
BROOKLYN NY
11212-3139
US

V. Phone/Fax

Practice location:
  • Phone: 718-250-8000
  • Fax:
Mailing address:
  • Phone:
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code207P00000X
TaxonomyEmergency Medicine Physician
License Number344378
License Number StateNY
# 2
Primary TaxonomyY
Taxonomy Code2080P0204X
TaxonomyPediatric Emergency Medicine (Pediatrics) Physician
License Number344378
License Number StateNY

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: