Healthcare Provider Details

I. General information

NPI: 1144275173
Provider Name (Legal Business Name): OMID ROFEIM MD
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 05/25/2006
Last Update Date: 01/03/2013
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

233 7TH ST SUITE 203
GARDEN CITY NY
11530-5747
US

IV. Provider business mailing address

233 7TH ST SUITE 203
GARDEN CITY NY
11530-5747
US

V. Phone/Fax

Practice location:
  • Phone: 516-294-7666
  • Fax: 516-294-7672
Mailing address:
  • Phone: 516-294-7666
  • Fax: 516-294-7672

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code208800000X
TaxonomyUrology Physician
License Number210903
License Number StateNY

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: