MEDICARE: OMNISMART TUTORING CENTER

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	251C00000X	Developmentally Disabled Services Day Training Agency

General Provider Information

NPI Number	:	1417406687
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	OMNISMART TUTORING CENTER

Provider Business Mailing Address
First Line	:	1180 CLIFTON AVE
Second Line	:
City	:	CLIFTON
State	:	NJ
Zip	:	07013-3622
Country	:	US
Telephone Number	:	973-941-4380
Fax Number	:

Provider Business Practice Location Address
First Line	:	1180 CLIFTON AVE
Second Line	:
City	:	CLIFTON
State	:	NJ
Zip	:	07013-3622
Country	:	US
Telephone Number	:	973-941-4380
Fax Number	:

Authorized Official
Title or Position	:	CEO
Name	:	ANWAAR A MANSOUR
Credential	:
Telephone Number	:	973-941-4380

Provider Enumeration Date	:	09/28/2016
Last Update Date	:	09/28/2016

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Directions to “OMNISMART TUTORING CENTER ” Practice Location

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