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NPI Code Detail

MEDICARE: OMER TIPU PHYSICIAN PC

MEDICARE: OMER TIPU PHYSICIAN PC
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
1207QG0300XGeriatric Medicine (Family Medicine) Physician

Other Identifiers

# Provider Identifier Provider Identifier Type Provider Identifier State Provider Identifier Issuer
1MEDICAID ID Found: Get Medicaid Details using Online Medicaid Verification Program

General Provider Information

NPI Number : 1780004358
Entity Type Code : Organization
Provider Name (Legal Business Name) : OMER TIPU PHYSICIAN PC
Provider Business Mailing Address
First Line : 710 SUNNYVIEW OVAL
Second Line :
City : KEASBEY
State : NJ
Zip : 08832-1039
Country : US
Telephone Number : 718-972-4200
Fax Number :
Provider Business Practice Location Address
First Line : 446 MCDONALD AVE
Second Line :
City : BROOKLYN
State : NY
Zip : 11218-2212
Country : US
Telephone Number : 718-972-4200
Fax Number :
Authorized Official
Title or Position : PRESIDENT
Name : OMER TIPU
Credential : MD
Telephone Number : 718-972-4200
Provider Enumeration Date : 04/23/2014
Last Update Date : 08/01/2014

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Directions to “OMER TIPU PHYSICIAN PC ” Practice Location

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