Provider Demographics
NPI:1902120256
Name:OMNI PAIN AND WELLNESS CENTERS, LLC
Entity Type:Organization
Organization Name:OMNI PAIN AND WELLNESS CENTERS, LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:DIRECTOR OF BUSINESS DEVELOPMENT
Authorized Official - Prefix:MR
Authorized Official - First Name:JOHN
Authorized Official - Middle Name:EDWARD
Authorized Official - Last Name:KUBIAK
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:716-667-1980
Mailing Address - Street 1:4855 CAMP RD
Mailing Address - Street 2:SUITE 400
Mailing Address - City:HAMBURG
Mailing Address - State:NY
Mailing Address - Zip Code:14075-2600
Mailing Address - Country:US
Mailing Address - Phone:716-649-1612
Mailing Address - Fax:716-649-1663
Practice Address - Street 1:4855 CAMP RD
Practice Address - Street 2:SUITE 400
Practice Address - City:HAMBURG
Practice Address - State:NY
Practice Address - Zip Code:14075-2600
Practice Address - Country:US
Practice Address - Phone:716-649-1612
Practice Address - Fax:716-649-1663
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2010-03-16
Last Update Date:2010-03-16
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes332B00000XSuppliersDurable Medical Equipment & Medical Supplies
No335E00000XSuppliersProsthetic/Orthotic Supplier