Omar a Ibrahimi MD PHD LLC

Primary specialty

MOHS-Micrographic Surgery PhysicianTaxonomy code 207ND0101X

License

049530 Issued in CT

Legal business name

OMAR A IBRAHIMI MD PHD LLC

Practice address

2777 Summer St Ste 600
Stamford, CT 06905-4323

Phone

(203) 428-4440

Fax

(901) 221-4916

NPI assigned

Jul 30, 2012

Organization subpart

No

Registry information is reported by the provider to CMS and is not verified. About this source

Authorized official

Name

Omar A IbrahimiNPI 1508061128

Title

Owner

Phone

(203) 428-4440

Specialties & licenses 1

Addresses

Other names 1

• Connecticut Skin Institute Doing business as

Medicare fee-for-service enrollment

Enrolled in CT

Enrollment records 1

These CMS records do not include an NPI. They are shown because their name and street address match this provider’s.

CLIA laboratory certificates

Locations

Practitioners 7

Individual providers connected to this organization through Medicare benefit reassignment, Care Compare group membership or National Provider Directory roles.

• Omar A Ibrahimi, MD, PHD

  • MOHS-Micrographic Surgery Physician
  • Stamford, CT
  • NPI 1508061128
  Medicare reassignment Care Compare group NPD Authorized official
• Fatima Rauf Bawany, MD

  • Dermatology Physician
  • Stamford, CT
  • NPI 1104406925
  Medicare reassignment Care Compare group NPD
• Sang H Kim, M.D.

  • Dermatology Physician
  • Norwalk, CT
  • NPI 1942318209
  Medicare reassignment Care Compare group NPD
• Samuel Gettler, MD

  • Dermatology Physician
  • Stamford, CT
  • NPI 1841221264
  Medicare reassignment NPD
• Elizabeth Choe

  • Medical Physician Assistant
  • Orange, CT
  • NPI 1063594380
  Medicare reassignment
• Matthew James Fedullo, PA-C

  • Physician Assistant
  • Stamford, CT
  • NPI 1831048602
  NPD (past)
• Lubna Latif

  • Physician Assistant
  • Stamford, CT
  • NPI 1598222119
  NPD (past)

The complete NPPES record for this NPI in the NPI Registry API format.

{
    "created_epoch": "1343606400000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1686441600000",
    "number": "1013263847",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "2777 SUMMER ST STE 600",
            "city": "STAMFORD",
            "state": "CT",
            "postal_code": "069054323",
            "telephone_number": "917-301-3781",
            "fax_number": "901-221-4916"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "2777 SUMMER ST STE 600",
            "city": "STAMFORD",
            "state": "CT",
            "postal_code": "069054323",
            "telephone_number": "203-428-4440",
            "fax_number": "901-221-4916"
        }
    ],
    "practiceLocations": [
        {
            "address_1": "60 Commerce Park Ste C",
            "address_purpose": "LOCATION",
            "city": "Milford",
            "state": "CT",
            "postal_code": "064603513",
            "country_code": "US",
            "telephone_number": "203-428-4440",
            "fax_number": "901-221-4916",
            "country_name": "United States",
            "address_type": "DOM"
        }
    ],
    "basic": {
        "organization_name": "OMAR A IBRAHIMI MD PHD LLC",
        "organizational_subpart": "NO",
        "enumeration_date": "2012-07-30",
        "last_updated": "2023-06-11",
        "certification_date": "2023-06-11",
        "status": "A",
        "authorized_official_last_name": "IBRAHIMI",
        "authorized_official_first_name": "OMAR",
        "authorized_official_middle_name": "A",
        "authorized_official_title_or_position": "OWNER",
        "authorized_official_telephone_number": "203-428-4440"
    },
    "taxonomies": [
        {
            "code": "207ND0101X",
            "taxonomy_group": "193400000X SINGLE SPECIALTY  GROUP",
            "desc": "Dermatology, MOHS-Micrographic Surgery",
            "state": "CT",
            "license": "049530",
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": [
        {
            "organization_name": "Connecticut Skin Institute",
            "code": "3",
            "type": "Doing Business As"
        }
    ]
}

• Maria Apuzzo Okon
• Olive Marchh LLC
• Grace Oliver, CCC/SLP
• Katherine Olson, LCSW
• Megan Olson
• Aye Omoruyi, PA-C
• Chinoye J Onyebuchi, NP
• Anil George Oommen, RPH
• Optimus Health Care
• Optimus Health Care Inc

• MOHS-Micrographic Surgery Physician in Stamford, CT
• Providers in Stamford, CT by specialty
• MOHS-Micrographic Surgery Physician in Connecticut

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Jun 11, 2023; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
• Medicare enrollment (CMS PECOS): enrollments, PAC IDs and benefit reassignments.
• Medicare Care Compare (CMS): clinician profile, group practices, facility affiliations, MIPS scores and star ratings.
• National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.

Verify at the official NPI Registry.