Provider Demographics
NPI:1841863461
Name:GURBAN, OMAR (NP-C)
Entity type:Individual
Prefix:MR
First Name:OMAR
Middle Name:
Last Name:GURBAN
Suffix:
Gender:M
Credentials:NP-C
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:462A LIBERTY STREET
Mailing Address - Street 2:UNIT 201
Mailing Address - City:LITTLE FERRY
Mailing Address - State:NJ
Mailing Address - Zip Code:07643
Mailing Address - Country:US
Mailing Address - Phone:347-400-2985
Mailing Address - Fax:
Practice Address - Street 1:462A LIBERTY STREET
Practice Address - Street 2:UNIT 201
Practice Address - City:LITTLE FERRY
Practice Address - State:NJ
Practice Address - Zip Code:07643
Practice Address - Country:US
Practice Address - Phone:347-400-2985
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2021-07-21
Last Update Date:2021-07-21
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NJ26NJ01176600363LA2200X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LA2200XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerAdult Health