Omer Tipu Physician PC

Primary specialty

Geriatric Medicine (Family Medicine) PhysicianTaxonomy code 207QG0300X

Legal business name

OMER TIPU PHYSICIAN PC

Practice address

446 McDonald Ave
Brooklyn, NY 11218-2212

Phone

(718) 972-4200

NPI assigned

Apr 23, 2014

Organization subpart

No

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

Authorized official

Name

Omer Tipu, MDNPI 1669601159

Title

President

Phone

(718) 972-4200

Specialties & licenses 1

Addresses

Other identifiers 1

Medicare fee-for-service enrollment

Enrolled in NY

Enrollment records 1

Practitioners 1

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

• Omer Khalique Tipu, MD

  • Family Medicine Physician
  • Brooklyn, NY
  • NPI 1669601159

  Geriatric Medicine

  Medicare reassignment NPD Authorized official

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

{
    "created_epoch": "1398211200000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1406851200000",
    "number": "1780004358",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "710 SUNNYVIEW OVAL",
            "city": "KEASBEY",
            "state": "NJ",
            "postal_code": "088321039",
            "telephone_number": "718-972-4200"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "446 MCDONALD AVE",
            "city": "BROOKLYN",
            "state": "NY",
            "postal_code": "112182212",
            "telephone_number": "718-972-4200"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "OMER TIPU PHYSICIAN PC",
        "organizational_subpart": "NO",
        "enumeration_date": "2014-04-23",
        "last_updated": "2014-08-01",
        "status": "A",
        "authorized_official_last_name": "TIPU",
        "authorized_official_first_name": "OMER",
        "authorized_official_title_or_position": "PRESIDENT",
        "authorized_official_telephone_number": "718-972-4200",
        "authorized_official_credential": "MD"
    },
    "taxonomies": [
        {
            "code": "207QG0300X",
            "taxonomy_group": "193400000X SINGLE SPECIALTY  GROUP",
            "desc": "Family Medicine, Geriatric Medicine",
            "state": null,
            "license": null,
            "primary": true
        }
    ],
    "identifiers": [
        {
            "code": "05",
            "desc": "MEDICAID",
            "issuer": null,
            "identifier": "03850084",
            "state": "NY"
        }
    ],
    "endpoints": [],
    "other_names": []
}

• Omega Diagnostic Imaging, P.C.
• Omega Kids Inc.
• Omega Physical Therapy,PC
• Alina Omelkina, COTA
• Omer Corp.
• Toba Olushola Omidiji, NP
• Mohammadmehdi Omidvari, M.D.
• Ajiroghene David Ominiabohs, LPN
• Anna V Omirska-Dyczek, DDS
• Makeda Omiss

• Geriatric Medicine (Family Medicine) Physician in Brooklyn, NY
• Providers in Brooklyn, NY by specialty
• Geriatric Medicine (Family Medicine) Physician in New York

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Aug 1, 2014; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
• Medicare enrollment (CMS PECOS): enrollments, PAC IDs and benefit reassignments.
• National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.

Verify at the official NPI Registry.