Active NPI
Omar Dian Bennett, MD
- Emergency Medicine Physician
- Newark, NJ
National Provider Identifier
1770311052
On this page
Key facts
NPPES NPI Registry- Primary specialty
- Emergency Medicine Physician
- License
- 00000000
- Practice address
- 150 Bergen Street
Newark
Newark, NJ 07103 - Phone
- (973) 972-4300
- NPI assigned
- Jul 26, 2024
- Sex
- Male
- Sole proprietor
- No
NPPES NPI Registry
Registry information is reported by the provider to CMS and is not verified. About this source
Specialties & licenses 1
| Specialty (taxonomy) | Code | License | State | Primary |
|---|---|---|---|---|
| Emergency Medicine Physician | 207P00000X | 00000000 | NJ | Primary |
Addresses
Primary practice location
150 Bergen Street
Newark
Newark, NJ 07103
Mailing address
353 S Center St Apt 16B
Orange, NJ 07050-3367
Phone (347) 338-7113
Medicare participation
Medicare enrollment files- Medicare fee-for-service enrollment
- Not listed in the public Medicare enrollment file
National Provider Directory
National Provider Directory- Medicare enrollment (NPD)
- Not enrolled
- Credentials
- Doctor of Medicine
State licenses
| License | State | Type | Specialty |
|---|---|---|---|
| 00000000 | NJ | MD | Nurse Practitioner |
NPI Registry JSON
The complete NPPES record for this NPI in the NPI Registry API format.
{
"created_epoch": "1721952000000",
"enumeration_type": "NPI-1",
"last_updated_epoch": "1721952000000",
"number": "1770311052",
"addresses": [
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "MAILING",
"address_type": "DOM",
"address_1": "353 S CENTER ST APT 16B",
"city": "ORANGE",
"state": "NJ",
"postal_code": "070503367",
"telephone_number": "347-338-7113"
},
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "LOCATION",
"address_type": "DOM",
"address_1": "150 BERGEN STREET",
"address_2": "NEWARK",
"city": "NEWARK",
"state": "NJ",
"postal_code": "07103",
"telephone_number": "973-972-4300"
}
],
"practiceLocations": [],
"basic": {
"last_name": "BENNETT",
"first_name": "OMAR",
"middle_name": "DIAN",
"name_prefix": "Dr.",
"credential": "MD",
"sole_proprietor": "NO",
"sex": "M",
"enumeration_date": "2024-07-26",
"last_updated": "2024-07-26",
"certification_date": "2024-07-19",
"status": "A"
},
"taxonomies": [
{
"code": "207P00000X",
"taxonomy_group": "",
"desc": "Emergency Medicine",
"state": "NJ",
"license": "00000000",
"primary": true
}
],
"identifiers": [],
"endpoints": [],
"other_names": []
}Other providers in Newark, NJ
Sources for this page
- NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Jul 26, 2024; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
- National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.