=====================================================
General NPI Number Information
=====================================================
NPI Number | 1417033465
-----------------------------------------------------
Entity Type | Individual
-----------------------------------------------------
Provider Name | IMAN OSMAN MD
-----------------------------------------------------
Gender | Female
-----------------------------------------------------
=====================================================
Dates
=====================================================
Enumeration Date | 10/31/2006
-----------------------------------------------------
Last Update Date | 01/24/2011
-----------------------------------------------------
=====================================================
Provider Practice Location Address
=====================================================
Address Line | 1430 FIRST AVE
-----------------------------------------------------
City | NEW YORK
-----------------------------------------------------
State | NY
-----------------------------------------------------
Zip | 10016
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 212-263-9076
-----------------------------------------------------
Fax | 212-263-9090
-----------------------------------------------------
=====================================================
Provider Business Mailing Address
=====================================================
Address Line | 45 INTREPID PL PORT LIBERTE
-----------------------------------------------------
City | JERSEY CITY
-----------------------------------------------------
State | NJ
-----------------------------------------------------
Zip | 07305-5485
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 212-263-9076
-----------------------------------------------------
Fax | 212-263-9090
-----------------------------------------------------
=====================================================
Authorized Official
=====================================================
Title or Position |
-----------------------------------------------------
Name |
-----------------------------------------------------
Credential |
-----------------------------------------------------
Telephone |
-----------------------------------------------------
=====================================================
Scope of Practice (Provider's specialty)
=====================================================
Taxonomy #1
-----------------------------------------------------
Taxonomy Code | 208800000X
-----------------------------------------------------
Taxonomy Name | Urology Physician
-----------------------------------------------------
License Number | 229083-1
-----------------------------------------------------
License Number State | NY
-----------------------------------------------------