Healthcare Provider Details

I. General information

NPI: 1306936364
Provider Name (Legal Business Name): OMEGA NEUROLOGY , PA
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 10/13/2006
Last Update Date: 01/03/2008
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

250 BLOSSOM ST STE 230
WEBSTER TX
77598-4241
US

IV. Provider business mailing address

PO BOX 19803
HOUSTON TX
77224-9803
US

V. Phone/Fax

Practice location:
  • Phone: 281-333-4705
  • Fax: 281-554-6268
Mailing address:
  • Phone: 281-333-4705
  • Fax: 281-333-4796

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code2084N0400X
TaxonomyNeurology Physician
License Number
License Number State

VIII. Authorized Official

Name: DR. HASSAN ALI JAVANSHIR
Title or Position: PRESIDENT
Credential: M.D.
Phone: 281-333-4705