Provider Demographics
NPI:1871839639
Name:OMER CORP.
Entity type:Organization
Organization Name:OMER CORP.
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:CEO
Authorized Official - Prefix:MR
Authorized Official - First Name:USAMA
Authorized Official - Middle Name:
Authorized Official - Last Name:SHAPPAN
Authorized Official - Suffix:
Authorized Official - Credentials:PT
Authorized Official - Phone:347-993-1270
Mailing Address - Street 1:684 83RD ST
Mailing Address - Street 2:#2
Mailing Address - City:BROOKLYN
Mailing Address - State:NY
Mailing Address - Zip Code:11228-2816
Mailing Address - Country:US
Mailing Address - Phone:347-993-1270
Mailing Address - Fax:
Practice Address - Street 1:684 83RD ST
Practice Address - Street 2:#2
Practice Address - City:BROOKLYN
Practice Address - State:NY
Practice Address - Zip Code:11228-2816
Practice Address - Country:US
Practice Address - Phone:347-993-1270
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2012-12-26
Last Update Date:2012-12-26
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY017152-1252Y00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes252Y00000XAgenciesEarly Intervention Provider Agency