Provider Demographics
NPI:1922990001
Name:SWIDAN, OMAR AYMAN I E
Entity type:Individual
Prefix:MR
First Name:OMAR
Middle Name:AYMAN I E
Last Name:SWIDAN
Suffix:
Gender:M
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:239 94TH ST
Mailing Address - Street 2:
Mailing Address - City:BROOKLYN
Mailing Address - State:NY
Mailing Address - Zip Code:11209-6807
Mailing Address - Country:US
Mailing Address - Phone:347-583-4553
Mailing Address - Fax:
Practice Address - Street 1:677 4TH AEVNUE
Practice Address - Street 2:STORE
Practice Address - City:BROOKLYN
Practice Address - State:NY
Practice Address - Zip Code:11232
Practice Address - Country:US
Practice Address - Phone:718-499-7410
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2025-07-15
Last Update Date:2025-07-15
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY071559183500000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes183500000XPharmacy Service ProvidersPharmacist