MEDICARE: DR. OMNIA M SAMRA LATIF ESTAFAN 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	207V00000X	Obstetrics & Gynecology Physician	MA07687	NJ

General Provider Information

NPI Number	:	1174515902
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	DR. OMNIA M SAMRA LATIF ESTAFAN MD

Provider Business Mailing Address
First Line	:	1255 WHITEHORSE MERCERVILLE RD STE 507
Second Line	:
City	:	HAMILTON
State	:	NJ
Zip	:	08619-3800
Country	:	US
Telephone Number	:	609-588-0185
Fax Number	:	609-588-0418

Provider Business Practice Location Address
First Line	:	1255 WHITEHORSE MERCERVILLE RD STE 507
Second Line	:
City	:	HAMILTON
State	:	NJ
Zip	:	08619-3800
Country	:	US
Telephone Number	:	609-588-0185
Fax Number	:	609-588-0418

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

Provider Enumeration Date	:	08/18/2005
Last Update Date	:	01/27/2025

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