Provider Demographics
NPI:1053812057
Name:ROUSAN, OMAR (NEMT TRANSPORTER)
Entity type:Individual
Prefix:
First Name:OMAR
Middle Name:
Last Name:ROUSAN
Suffix:
Gender:M
Credentials:NEMT TRANSPORTER
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:6 ROYAL CREST DR APT 3
Mailing Address - Street 2:
Mailing Address - City:NASHUA
Mailing Address - State:NH
Mailing Address - Zip Code:03060-5407
Mailing Address - Country:US
Mailing Address - Phone:401-999-5666
Mailing Address - Fax:603-402-9675
Practice Address - Street 1:6 ROYAL CREST DR APT 3
Practice Address - Street 2:
Practice Address - City:NASHUA
Practice Address - State:NH
Practice Address - Zip Code:03060-5407
Practice Address - Country:US
Practice Address - Phone:401-999-5666
Practice Address - Fax:603-402-9675
Is Sole Proprietor?:Yes
Enumeration Date:2018-02-24
Last Update Date:2018-02-24
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NH788753171W00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes171W00000XOther Service ProvidersContractor