Provider Demographics
NPI:1962277194
Name:OMNI MEDICAL OF NJ PC
Entity type:Organization
Organization Name:OMNI MEDICAL OF NJ PC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PRESIDENT
Authorized Official - Prefix:
Authorized Official - First Name:ALI
Authorized Official - Middle Name:
Authorized Official - Last Name:ABOUFARES
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:212-319-3977
Mailing Address - Street 1:1009 79TH ST STE 1
Mailing Address - Street 2:
Mailing Address - City:NORTH BERGEN
Mailing Address - State:NJ
Mailing Address - Zip Code:07047-4981
Mailing Address - Country:US
Mailing Address - Phone:212-319-3977
Mailing Address - Fax:212-721-0806
Practice Address - Street 1:1009 79TH ST STE 1
Practice Address - Street 2:
Practice Address - City:NORTH BERGEN
Practice Address - State:NJ
Practice Address - Zip Code:07047-4981
Practice Address - Country:US
Practice Address - Phone:212-319-3977
Practice Address - Fax:212-721-0806
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2023-11-17
Last Update Date:2024-03-20
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes207RI0011XAllopathic & Osteopathic PhysiciansInternal MedicineInterventional CardiologyGroup - Multi-Specialty
No2085R0204XAllopathic & Osteopathic PhysiciansRadiologyVascular & Interventional RadiologyGroup - Multi-Specialty
No208VP0014XAllopathic & Osteopathic PhysiciansPain MedicineInterventional Pain MedicineGroup - Multi-Specialty