Provider Demographics
NPI:1174515902
Name:SAMRA LATIF ESTAFAN, OMNIA M (MD)
Entity type:Individual
Prefix:DR
First Name:OMNIA
Middle Name:M
Last Name:SAMRA LATIF ESTAFAN
Suffix:
Gender:F
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1255 WHITEHORSE MERCERVILLE RD STE 507
Mailing Address - Street 2:
Mailing Address - City:HAMILTON
Mailing Address - State:NJ
Mailing Address - Zip Code:08619-3800
Mailing Address - Country:US
Mailing Address - Phone:609-588-0185
Mailing Address - Fax:609-588-0418
Practice Address - Street 1:1255 WHITEHORSE MERCERVILLE RD STE 507
Practice Address - Street 2:
Practice Address - City:HAMILTON
Practice Address - State:NJ
Practice Address - Zip Code:08619-3800
Practice Address - Country:US
Practice Address - Phone:609-588-0185
Practice Address - Fax:609-588-0418
Is Sole Proprietor?:Yes
Enumeration Date:2005-08-18
Last Update Date:2025-01-27
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NJMA07687207V00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207V00000XAllopathic & Osteopathic PhysiciansObstetrics & Gynecology
Provider Identifiers
StateIdentifier IDID TypeIssuer
NJ089273Medicare ID - Type Unspecified
H69483Medicare UPIN
NJ8997501Medicare ID - Type Unspecified