Provider Demographics
NPI:1699451690
Name:ISMAIL, OMAR IBNEE
Entity type:Individual
Prefix:MR
First Name:OMAR
Middle Name:IBNEE
Last Name:ISMAIL
Suffix:
Gender:M
Credentials:
Other - Prefix:
Other - First Name:M OMAR
Other - Middle Name:IBNEE
Other - Last Name:ISMAIL
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:
Mailing Address - Street 1:345 E 24TH ST
Mailing Address - Street 2:
Mailing Address - City:NEW YORK
Mailing Address - State:NY
Mailing Address - Zip Code:10010-4020
Mailing Address - Country:US
Mailing Address - Phone:212-998-9800
Mailing Address - Fax:
Practice Address - Street 1:400 W ALLEGHENY AVE STE B1
Practice Address - Street 2:
Practice Address - City:PHILADELPHIA
Practice Address - State:PA
Practice Address - Zip Code:19133-3614
Practice Address - Country:US
Practice Address - Phone:215-291-9200
Practice Address - Fax:215-278-7596
Is Sole Proprietor?:No
Enumeration Date:2023-06-23
Last Update Date:2024-08-23
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY390200000X
PADS0448451223G0001X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1223G0001XDental ProvidersDentistGeneral Practice
No390200000XStudent, Health CareStudent in an Organized Health Care Education/Training Program