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General NPI Number Information
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NPI Number | 1598696247
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Entity Type | Individual
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Provider Name | MOHAMED OMAR
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Gender | Male
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Dates
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Enumeration Date | 05/28/2026
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Last Update Date | 05/28/2026
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Provider Practice Location Address
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Address Line | 2506 N ROOSEVELT BLVD
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City | KEY WEST
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State | FL
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Zip | 33040-3950
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Country | US
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Telephone | 305-434-9205
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Fax |
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Provider Business Mailing Address
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Address Line | 1589 ANDERSON AVE
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City | FORT LEE
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State | NJ
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Zip | 07024-2743
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Country | US
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Telephone |
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Fax |
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Authorized Official
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Title or Position |
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Name |
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Credential |
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Telephone |
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 156F00000X
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Taxonomy Name | Technician/Technologist
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License Number | 59654
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License Number State | FL
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