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General NPI Number Information
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NPI Number | 1043519416
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Entity Type | Organization
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Legal Business Name | OMAR T COCKEY DMD PA
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Dates
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Enumeration Date | 03/24/2011
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Last Update Date | 03/24/2011
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Provider Practice Location Address
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Address Line | 703 MAIN ST
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City | PATERSON
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State | NJ
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Zip | 07503-2621
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Country | US
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Telephone | 973-779-6183
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Fax | 973-779-6183
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Provider Business Mailing Address
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Address Line | PO BOX 115
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City | MONTCLAIR
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State | NJ
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Zip | 07042-0115
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Country | US
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Telephone | 973-779-6183
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Fax | 973-779-6183
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Authorized Official
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Title or Position | CEO
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Name | DR. OMAR T COCKEY
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Credential | DMD
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Telephone | 973-779-6183
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 261Q00000X
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Taxonomy Name | Clinic/Center
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License Number | DI 17684
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License Number State | NJ
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Taxonomy #2
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Taxonomy Code | 261QD0000X
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Taxonomy Name | Dental Clinic/Center
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License Number | DI 17684
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License Number State | NJ
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