Healthcare Provider Details

I. General information

NPI: 1669653184
Provider Name (Legal Business Name): ROY GEORGI OOMMEN MD
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 11/27/2007
Last Update Date: 08/05/2024
Certification Date: 08/05/2024
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1978 CROMPOND RD
CORTLANDT MANOR NY
10567-4111
US

IV. Provider business mailing address

50 DAYTON LN SUITE 202
PEEKSKILL NY
10566-2859
US

V. Phone/Fax

Practice location:
  • Phone: 914-293-8600
  • Fax: 914-293-8606
Mailing address:
  • Phone: 914-739-0087
  • Fax: 914-737-1714

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code208600000X
TaxonomySurgery Physician
License Number1563394012
License Number StateCT
# 2
Primary TaxonomyN
Taxonomy Code208G00000X
TaxonomyThoracic Surgery (Cardiothoracic Vascular Surgery) Physician
License Number247213
License Number StateMA
# 3
Primary TaxonomyY
Taxonomy Code208G00000X
TaxonomyThoracic Surgery (Cardiothoracic Vascular Surgery) Physician
License Number255950
License Number StateNY

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: