Provider Demographics
NPI:1588048698
Name:OMAR, HALA
Entity type:Individual
Prefix:
First Name:HALA
Middle Name:
Last Name:OMAR
Suffix:
Gender:F
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:5732 136TH ST
Mailing Address - Street 2:
Mailing Address - City:FLUSHING
Mailing Address - State:NY
Mailing Address - Zip Code:11355-5201
Mailing Address - Country:US
Mailing Address - Phone:917-826-2520
Mailing Address - Fax:
Practice Address - Street 1:311 E SPRUCE ST STE 3B
Practice Address - Street 2:
Practice Address - City:GARDEN CITY
Practice Address - State:KS
Practice Address - Zip Code:67846-5685
Practice Address - Country:US
Practice Address - Phone:620-275-3740
Practice Address - Fax:620-275-3761
Is Sole Proprietor?:No
Enumeration Date:2015-07-17
Last Update Date:2021-08-04
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
390200000X
KS04-44968208600000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes208600000XAllopathic & Osteopathic PhysiciansSurgery
No390200000XStudent, Health CareStudent in an Organized Health Care Education/Training Program