MEDICARE: DR. OMID HAKIMIAN MD

Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

#	Taxonomy Code	Taxonomy	License Number	License Number State
1	208800000X	Urology Physician	207562-1	NY
2	208800000X	Urology Physician	207562	NY

Other Identifiers

#	Provider Identifier	Provider Identifier Type	Provider Identifier State	Provider Identifier Issuer
1	MEDICAID ID Found: Get Medicaid Details using Online Medicaid Verification Program
2	207562	OTHER	NY	LICENSE #

General Provider Information

NPI Number	:	1164418166
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	DR. OMID HAKIMIAN MD

Provider Business Mailing Address
First Line	:	75-54 METROPOLITAN AVENUE
Second Line	:	2ND FLOOR
City	:	MIDDLE VILLAGE
State	:	NY
Zip	:	11379
Country	:	US
Telephone Number	:	718-769-5158
Fax Number	:	718-646-4087

Provider Business Practice Location Address
First Line	:	75-54 METROPOLITAN AVENUE
Second Line	:	2ND FLOOR
City	:	MIDDLE VILLAGE
State	:	NY
Zip	:	11379
Country	:	US
Telephone Number	:	718-894-4200
Fax Number	:	718-416-4471

Authorized Official
Title or Position	:
Name	:
Credential	:
Telephone Number	:

Provider Enumeration Date	:	09/25/2005
Last Update Date	:	02/19/2015

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