Healthcare Provider Details

I. General information

NPI: 1275736050
Provider Name (Legal Business Name): OMAR E ETON MD
Entity Type: Individual
Gender: Male
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 06/07/2007
Last Update Date: 06/02/2026
Certification Date: 06/02/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

327 BEACH 19TH ST
FAR ROCKAWAY NY
11691-4423
US

IV. Provider business mailing address

34 LARCHWOOD DR
CAMBRIDGE MA
02138-4606
US

V. Phone/Fax

Practice location:
  • Phone: 718-869-7000
  • Fax:
Mailing address:
  • Phone: 617-955-0100
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code207RH0003X
TaxonomyHematology & Oncology Physician
License Number166561
License Number StateNY
# 2
Primary TaxonomyN
Taxonomy Code207RH0003X
TaxonomyHematology & Oncology Physician
License Number230372
License Number StateMA
# 3
Primary TaxonomyN
Taxonomy Code207RX0202X
TaxonomyMedical Oncology Physician
License NumberG7403
License Number StateTX
# 4
Primary TaxonomyY
Taxonomy Code207RH0003X
TaxonomyHematology & Oncology Physician
License Number56793
License Number StateCT
# 5
Primary TaxonomyN
Taxonomy Code207RX0202X
TaxonomyMedical Oncology Physician
License Number116561
License Number StateNY
# 6
Primary TaxonomyN
Taxonomy Code207R00000X
TaxonomyInternal Medicine Physician
License Number230372
License Number StateMA
# 7
Primary TaxonomyN
Taxonomy Code207RX0202X
TaxonomyMedical Oncology Physician
License Number39217
License Number StateNH

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: