Individual
OMAR CANOSA
Active
Sole proprietor
Yes
Provider details
NPI number
Gender
Man
Credential
M.D.
Contact information
Practice address
37 KINGS RD, STE 202, MADISON, NJ 07940-2500
(973) 520-8848
(973) 200-8088
Mailing address
37 KINGS RD, STE 202, MADISON, NJ 07940-2500
(973) 520-8848
(973) 200-8088
Taxonomy
Speciality
Code
Description
License number
State
2084P0800X
Psychiatry Physician
MD427434
PA
2084P0804X
Child & Adolescent Psychiatry Physician
Primary
25MA08381800
NJ
Other
Other identifiers
Code
Description
Identifier
Issuer
State
01
—
25MA08381800
LICENSE NUMBER
NJ
01
—
MD427434
LICENSE NUMBER
PA
Enumeration date
05/16/2006
Last updated
06/13/2014
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