Healthcare Provider Details

I. General information

NPI: 1053324913
Provider Name (Legal Business Name): OMAR S ALIBRAHIM MD
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 08/14/2006
Last Update Date: 08/17/2021
Certification Date: 08/17/2021
Deactivation Date:
Reactivation Date:

III. Provider practice location address

219 BRYANT STREET
BUFFALO NY
14222-2006
US

IV. Provider business mailing address

4511 HARLEM ROAD SUITE 202
AMHERST NY
14226-3822
US

V. Phone/Fax

Practice location:
  • Phone: 716-878-7442
  • Fax: 716-878-7101
Mailing address:
  • Phone: 716-839-6720
  • Fax: 716-839-6740

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code208000000X
TaxonomyPediatrics Physician
License Number002564
License Number StateNY
# 2
Primary TaxonomyN
Taxonomy Code2080P0203X
TaxonomyPediatric Critical Care Medicine Physician
License Number002564
License Number StateNY
# 3
Primary TaxonomyY
Taxonomy Code2080P0204X
TaxonomyPediatric Emergency Medicine (Pediatrics) Physician
License Number002564
License Number StateNY

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: