Provider Demographics
NPI:1447721840
Name:OMALIA, MARK JOSEPH JR (MS, CCC-SLP)
Entity type:Individual
Prefix:
First Name:MARK
Middle Name:JOSEPH
Last Name:OMALIA
Suffix:JR
Gender:M
Credentials:MS, CCC-SLP
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:27 W 20TH ST STE 1203
Mailing Address - Street 2:
Mailing Address - City:NEW YORK
Mailing Address - State:NY
Mailing Address - Zip Code:10011-3722
Mailing Address - Country:US
Mailing Address - Phone:212-633-6400
Mailing Address - Fax:
Practice Address - Street 1:27 W 20TH ST STE 1203
Practice Address - Street 2:
Practice Address - City:NEW YORK
Practice Address - State:NY
Practice Address - Zip Code:10011-3722
Practice Address - Country:US
Practice Address - Phone:570-592-1784
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2018-12-10
Last Update Date:2018-12-10
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY028165235Z00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes235Z00000XSpeech, Language and Hearing Service ProvidersSpeech-Language Pathologist