MEDICARE: DR. ANNIE OOMMEN 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	208600000X	Surgery Physician	263265	NY

General Provider Information

NPI Number	:	1679756159
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	DR. ANNIE OOMMEN MD

Provider Business Mailing Address
First Line	:	73 MARKET ST
Second Line	:	SUITE 214
City	:	YONKERS
State	:	NY
Zip	:	10710-7602
Country	:	US
Telephone Number	:	914-848-8960
Fax Number	:

Provider Business Practice Location Address
First Line	:	73 MARKET ST
Second Line	:	SUITE 214
City	:	YONKERS
State	:	NY
Zip	:	10710-7602
Country	:	US
Telephone Number	:	914-848-8960
Fax Number	:

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

Provider Enumeration Date	:	12/07/2007
Last Update Date	:	10/16/2013

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