1568147478 NPI number — OMNIA SAAD HANAFY MAHMOUD PA-C

Table of content: OMNIA SAAD HANAFY MAHMOUD PA-C (NPI 1568147478)

General

This information contains only most important part of the NPI data, for complete information, including NPI referencing materials please refer to 1568147478 NPI number — OMNIA SAAD HANAFY MAHMOUD PA-C

Organization/Personal Information

Employer Identification Number (EIN):
Provider Organization Name:
Provider Last Name:
MAHMOUD
Provider First Name:
OMNIA
Provider Middle Name:
SAAD HANAFY
Provider Name Prefix Text:
Provider Name Suffix Text:
Provider Credential Text:
PA-C
Provider Gender Code:
F

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:
1568147478
Entity Type Code:
Individual
Replacement NPI:
Last Update Date:
08/07/2024
NPI Deactivation Reason Code:
NPI Deactivation Date:
NPI Reactivation Date:

Provider's Business Mailing Address

Provider First Line Business Mailing Address:
100 METROPOLITAN PARK DR STE 100
Provider Second Line Business Mailing Address:
Provider Business Mailing Address City Name:
LIVERPOOL
Provider Business Mailing Address State Name:
NY
Provider Business Mailing Address Postal Code:
13088-7112
Provider Business Mailing Address Country Code:
US
Provider Business Mailing Address Telephone Number:
315-870-9369
Provider Business Mailing Address Fax Number:
315-870-9364

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
5100 W TAFT RD STE 4D
Provider Second Line Business Practice Location Address:
Provider Business Practice Location Address City Name:
LIVERPOOL
Provider Business Practice Location Address State Name:
NY
Provider Business Practice Location Address Postal Code:
13088-3810
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
315-458-6669
Provider Business Practice Location Address Fax Number:
315-458-0819
Provider Enumeration Date:
06/19/2023

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: 363A00000X , with the licence number:  030218 , 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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