Provider Demographics
NPI:1639285919
Name:OMIC INC
Entity type:Organization
Organization Name:OMIC INC
Other - Org Name:<UNAVAIL>
Other - Org Type:
Authorized Official - Title/Position:DIRECTOR
Authorized Official - Prefix:
Authorized Official - First Name:YALDAR
Authorized Official - Middle Name:T
Authorized Official - Last Name:TAHER
Authorized Official - Suffix:
Authorized Official - Credentials:DPT
Authorized Official - Phone:973-652-8595
Mailing Address - Street 1:550 KINDERKAMACK RD
Mailing Address - Street 2:
Mailing Address - City:ORADELL
Mailing Address - State:NJ
Mailing Address - Zip Code:07649-1500
Mailing Address - Country:US
Mailing Address - Phone:201-599-8100
Mailing Address - Fax:201-599-8480
Practice Address - Street 1:550 KINDERKAMACK RD
Practice Address - Street 2:
Practice Address - City:ORADELL
Practice Address - State:NJ
Practice Address - Zip Code:07649-1500
Practice Address - Country:US
Practice Address - Phone:201-599-8100
Practice Address - Fax:201-599-8480
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-08-21
Last Update Date:2016-09-12
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NJ22785 & 22787261QR0200X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes261QR0200XAmbulatory Health Care FacilitiesClinic/CenterRadiology
Provider Identifiers
StateIdentifier IDID TypeIssuer
NJ7610602Medicaid
NJ7610602Medicaid