Individual
MOHAMED OMAR ATWAIBI
Active
Sole proprietor
No
Provider details
NPI number
Gender
Man
Credential
M.D
Contact information
Practice address
200 MADISON AVE, SUITE 2C, ELMIRA, NY 14901-3218
(607) 737-4339
(607) 737-1519
Mailing address
571 SAINT JOSEPHS BLVD FL 2, ELMIRA, NY 14901-3230
(607) 271-2050
Taxonomy
Speciality
Code
Description
License number
State
207R00000X
Internal Medicine Physician
21691
MN
207R00000X
Internal Medicine Physician
277637
NY
207RN0300X
Nephrology Physician
Primary
277637
NY
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
04013892
—
NY
01
—
J400316995
MEDICARE PTAN
NY
Enumeration date
07/06/2009
Last updated
09/02/2016
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