1447721840 NPI number — MARK JOSEPH OMALIA JR. MS, CCC-SLP

Table of content: MARK JOSEPH OMALIA JR. MS, CCC-SLP (NPI 1447721840)

General

This information contains only most important part of the NPI data, for complete information, including NPI referencing materials please refer to 1447721840 NPI number — MARK JOSEPH OMALIA JR. MS, CCC-SLP

Organization/Personal Information

Employer Identification Number (EIN):
Provider Organization Name:
Provider Last Name:
OMALIA
Provider First Name:
MARK
Provider Middle Name:
JOSEPH
Provider Name Prefix Text:
Provider Name Suffix Text:
JR.
Provider Credential Text:
MS, CCC-SLP
Provider Gender Code:
M

Provider's Other Name Information

Provider Other Organization Name:
Provider Other Organization Name Type Code:
Provider Other Last Name:
Provider Other First Name:
Provider Other Middle Name:
Provider Other Name Prefix Text:
Provider Other Name Suffix Text:
Provider Other Credential Text:
Provider Other Last Name Type Code:

NPI Number Information

NPI Number:
1447721840
Entity Type Code:
Individual
Replacement NPI:
Last Update Date:
12/10/2018
NPI Deactivation Reason Code:
NPI Deactivation Date:
NPI Reactivation Date:

Provider's Business Mailing Address

Provider First Line Business Mailing Address:
27 W 20TH ST STE 1203
Provider Second Line Business Mailing Address:
Provider Business Mailing Address City Name:
NEW YORK
Provider Business Mailing Address State Name:
NY
Provider Business Mailing Address Postal Code:
10011-3722
Provider Business Mailing Address Country Code:
US
Provider Business Mailing Address Telephone Number:
212-633-6400
Provider Business Mailing Address Fax Number:

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
27 W 20TH ST STE 1203
Provider Second Line Business Practice Location Address:
Provider Business Practice Location Address City Name:
NEW YORK
Provider Business Practice Location Address State Name:
NY
Provider Business Practice Location Address Postal Code:
10011-3722
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
570-592-1784
Provider Business Practice Location Address Fax Number:
Provider Enumeration Date:
12/10/2018

Additional Information

Authorized Official

Authorized Official Last Name:
Authorized Official First Name:
Authorized Official Middle Name:
Authorized Official Title or Position:
Authorized Official Telephone Number:

Provider Taxonomy Codes

  • Taxonomy code: 235Z00000X , with the licence number:  028165 , registered in the state of NY ; information, associated with the NPI states the following Primary Taxonomy Switch: "Y" .

Other Provider's Identifiers (legacy, non-NPI)





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