Healthcare Provider Details

I. General information

NPI: 1750133757
Provider Name (Legal Business Name): OMAR KHAYAT M.D
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 04/03/2024
Last Update Date: 03/03/2025
Certification Date:
Deactivation Date: 11/11/2024
Reactivation Date: 03/03/2025

III. Provider practice location address

475 SEAVIEW AVE STATEN ISLAND UNIVERSITY HOSPITAL DEPARTMENT OF MEDICIN
STATEN ISLAND NY
10305
US

IV. Provider business mailing address

475 SEAVIEW AVE STATEN ISLAND UNIVERSITY HOSPITAL DEPARTMENT OF MEDICIN
STATEN ISLAND NY
10305
US

V. Phone/Fax

Practice location:
  • Phone: 718-226-6993
  • Fax:
Mailing address:
  • Phone:
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code390200000X
TaxonomyStudent in an Organized Health Care Education/Training Program
License Number
License Number State

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: