Healthcare Provider Details

I. General information

NPI: 1972183259
Provider Name (Legal Business Name): OTHMAN ADIL MD
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 04/12/2021
Last Update Date: 08/03/2026
Certification Date: 08/03/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

425 MADISON AVE RM 200
NEW YORK NY
10017-1119
US

IV. Provider business mailing address

1198 3RD AVE
NEW YORK NY
10021-5102
US

V. Phone/Fax

Practice location:
  • Phone: 212-375-3304
  • Fax:
Mailing address:
  • Phone: 212-375-3304
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code2081S0010X
TaxonomySports Medicine (Physical Medicine & Rehabilitation) Physician
License Number344301
License Number StateNY

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: