Organization
MTO PRACTICE, LLC
Active
Organization
MTO PRACTICE, LLC
Active
Organization subpart
No
Provider details
NPI number
Authorized official
DR. KARAN OMIDVARI MD (OWNER)
(201) 967-8425
Entity
Organization
Contact information
Practice address
17 ELM AVE FL 3, HACKENSACK, NJ 07601-4702
(201) 967-8425
(201) 263-4665
Mailing address
170 E 87TH ST APT W11A, NEW YORK, NY 10128-2238
(201) 967-8425
(201) 263-4665
Taxonomy
Speciality
Code
Description
License number
State
207RC0200X
Critical Care Medicine (Internal Medicine) Physician
Primary
—
—
Other
Other identifiers
Code
Description
Identifier
Issuer
State
01
—
25MA05638100
STATE LICENSE
NJ
Enumeration date
12/05/2019
Last updated
01/07/2020
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