| Om Medical Center Llc. | |
|
12-15 Broadway Ste B Fair Lawn NJ 07410-2031 | |
| (201) 773-6868 | |
| (201) 773-6867 |
| Full Name | Om Medical Center Llc. |
|---|---|
| Speciality | Clinic/Center |
| Location | 12-15 Broadway Ste B, Fair Lawn, New Jersey |
| Authorized Official Name and Position | Dushyant R Patel (DOCTOR OWNER) |
| Authorized Official Contact | 2017736868 |
| Accepts Medicare Insurance | Yes. This clinic participates in medicare program and accept medicare insurance. |
| Mailing Address | Practice Location Address |
|---|---|
| Om Medical Center Llc. 12-15 Broadway Ste B Fair Lawn NJ 07410-2031 Ph: (201) 773-6868 | Om Medical Center Llc. 12-15 Broadway Ste B Fair Lawn NJ 07410-2031 Ph: (201) 773-6868 |
| NPI Number | 1346346103 |
|---|---|
| Provider Enumeration Date | 09/16/2006 |
| Last Update Date | 06/08/2010 |
| Medicare PECOS PAC ID | 0648375493 |
|---|---|
| Medicare Enrollment ID | O20070424000047 |
| Identifier | Type | State | Issuer |
|---|---|---|---|
| 1346346103 | NPI | - | NPPES |
| 0108871 | Medicaid | NJ |
| Taxonomy | Type | License (State) | Status |
|---|---|---|---|
| 261Q00000X | Clinic/center | (* (Not Available)) | Primary |
| Provider Name | Dushyant Patel |
|---|---|
| Provider Type | Practitioner - Internal Medicine |
| Provider Identifiers | NPI Number: 1750330072 PECOS PAC ID: 7719971100 Enrollment ID: I20070420000487 |
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