Healthcare Provider Details

I. General information

NPI: 1295167765
Provider Name (Legal Business Name): ALAN JAY OMINSKY MD
Entity Type: Individual
Gender: Male
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 08/06/2013
Last Update Date: 08/06/2013
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

233 S 6TH ST 712
PHILADELPHIA PA
19106-3749
US

IV. Provider business mailing address

233 S 6TH ST 712
PHILADELPHIA PA
19106-3749
US

V. Phone/Fax

Practice location:
  • Phone: 215-923-9994
  • Fax: 215-923-9997
Mailing address:
  • Phone: 215-923-9994
  • Fax: 215-923-9997

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code173000000X
TaxonomyLegal Medicine
License NumberMD007842E
License Number StatePA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: