Healthcare Provider Details

I. General information

NPI: 1124550173
Provider Name (Legal Business Name): OMAR IMAD RAMADAN M.D.
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 03/29/2017
Last Update Date: 09/09/2026
Certification Date: 09/09/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

161 FORT WASHINGTON AVE FL 5
NEW YORK NY
10032-3729
US

IV. Provider business mailing address

161 FORT WASHINGTON AVE FL 5
NEW YORK NY
10032-3729
US

V. Phone/Fax

Practice location:
  • Phone: 215-600-5739
  • Fax:
Mailing address:
  • Phone: 215-600-5739
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code2086S0129X
TaxonomyVascular Surgery Physician
License Number346137
License Number StateNY

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: