Provider Demographics
NPI:1912470683
Name:OMAR, ANSARI N (RN)
Entity type:Individual
Prefix:MR
First Name:ANSARI
Middle Name:N
Last Name:OMAR
Suffix:
Gender:M
Credentials:RN
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:8756 FRANCIS LEWIS BLVD APT A55
Mailing Address - Street 2:
Mailing Address - City:QUEENS VILLAGE
Mailing Address - State:NY
Mailing Address - Zip Code:11427-2830
Mailing Address - Country:US
Mailing Address - Phone:718-749-2360
Mailing Address - Fax:
Practice Address - Street 1:8756 FRANCIS LEWIS BLVD APT A55
Practice Address - Street 2:
Practice Address - City:QUEENS VILLAGE
Practice Address - State:NY
Practice Address - Zip Code:11427-2830
Practice Address - Country:US
Practice Address - Phone:718-749-2360
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2019-01-06
Last Update Date:2019-01-06
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY723923163WH0200X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes163WH0200XNursing Service ProvidersRegistered NurseHome Health