Healthcare Provider Details

I. General information

NPI: 1497811632
Provider Name (Legal Business Name): LALEH RACHEL OMRANI RPA-C
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 12/30/2006
Last Update Date: 11/30/2009
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

462 1ST AVE DEPARTMENT OF SURGERY ON 15SOUTH
NEW YORK NY
10016-9196
US

IV. Provider business mailing address

2 BELLINGHAM LN
GREAT NECK NY
11023-1302
US

V. Phone/Fax

Practice location:
  • Phone: 212-562-3917
  • Fax:
Mailing address:
  • Phone:
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code363A00000X
TaxonomyPhysician Assistant
License Number011263
License Number StateNY

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: