Provider Demographics
NPI:1972351336
Name:AL-GAILANI, OMAR MAZIN ABDULMUNEM (MD)
Entity type:Individual
Prefix:MR
First Name:OMAR
Middle Name:MAZIN ABDULMUNEM
Last Name:AL-GAILANI
Suffix:
Gender:M
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:75 NORTH COUNTRY ROAD
Mailing Address - Street 2:
Mailing Address - City:PORT JEFFERSON
Mailing Address - State:NY
Mailing Address - Zip Code:11777
Mailing Address - Country:US
Mailing Address - Phone:631-686-2549
Mailing Address - Fax:631-476-2874
Practice Address - Street 1:75 NORTH COUNTRY ROAD
Practice Address - Street 2:
Practice Address - City:PORT JEFFERSON
Practice Address - State:NY
Practice Address - Zip Code:11777
Practice Address - Country:US
Practice Address - Phone:631-686-2549
Practice Address - Fax:631-476-2874
Is Sole Proprietor?:No
Enumeration Date:2024-05-10
Last Update Date:2024-11-26
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes390200000XStudent, Health CareStudent in an Organized Health Care Education/Training Program