Provider Demographics
NPI:1548548225
Name:WAIN, OMAR (DO)
Entity type:Individual
Prefix:DR
First Name:OMAR
Middle Name:
Last Name:WAIN
Suffix:
Gender:M
Credentials:DO
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:PO BOX 621
Mailing Address - Street 2:
Mailing Address - City:WOODMERE
Mailing Address - State:NY
Mailing Address - Zip Code:11598-0621
Mailing Address - Country:US
Mailing Address - Phone:516-900-7922
Mailing Address - Fax:718-425-8911
Practice Address - Street 1:2000 N VILLAGE AVE STE 211
Practice Address - Street 2:
Practice Address - City:ROCKVILLE CENTRE
Practice Address - State:NY
Practice Address - Zip Code:11570
Practice Address - Country:US
Practice Address - Phone:516-900-7922
Practice Address - Fax:718-425-8911
Is Sole Proprietor?:Yes
Enumeration Date:2011-07-28
Last Update Date:2024-02-20
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY287144208600000X, 208600000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes208600000XAllopathic & Osteopathic PhysiciansSurgery