Provider Demographics
NPI:1861958464
Name:OSMAN, HAYTHAM E (CNIM)
Entity type:Individual
Prefix:
First Name:HAYTHAM
Middle Name:E
Last Name:OSMAN
Suffix:
Gender:M
Credentials:CNIM
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:344 GROVE ST # 4047
Mailing Address - Street 2:
Mailing Address - City:JERSEY CITY
Mailing Address - State:NJ
Mailing Address - Zip Code:07302-5923
Mailing Address - Country:US
Mailing Address - Phone:201-282-7246
Mailing Address - Fax:
Practice Address - Street 1:344 GROVE ST # 4047
Practice Address - Street 2:
Practice Address - City:JERSEY CITY
Practice Address - State:NJ
Practice Address - Zip Code:07302-5923
Practice Address - Country:US
Practice Address - Phone:201-282-7246
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2019-02-19
Last Update Date:2020-09-01
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
2734246ZE0600X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes246ZE0600XTechnologists, Technicians & Other Technical Service ProvidersSpecialist/Technologist, OtherElectroneurodiagnostic