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General NPI Number Information
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NPI Number | 1760746739
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Entity Type | Organization
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Legal Business Name | OMM, LLC
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Dates
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Enumeration Date | 06/25/2012
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Last Update Date | 06/25/2012
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Provider Practice Location Address
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Address Line | 11 OVERLOOK RD STE 140
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City | SUMMIT
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State | NJ
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Zip | 07901-3577
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Country | US
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Telephone | 973-507-6327
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Fax |
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Provider Business Mailing Address
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Address Line | 11 OVERLOOK RD STE 140
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City | SUMMIT
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State | NJ
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Zip | 07901-3577
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Country | US
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Telephone | 973-507-6327
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Fax |
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Authorized Official
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Title or Position | PHYSICIAN
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Name | STEVEN LEVINE
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Credential | D.O
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Telephone | 973-507-6327
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 204D00000X
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Taxonomy Name | Neuromusculoskeletal Medicine & OMM Physician
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License Number | MB36416
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License Number State | NJ
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