Provider Demographics
NPI:1083009781
Name:NAZARI, MOHAMAD JAWAD
Entity Type:Individual
Prefix:MR
First Name:MOHAMAD
Middle Name:JAWAD
Last Name:NAZARI
Suffix:
Gender:M
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:13955 35TH AVE
Mailing Address - Street 2:6F
Mailing Address - City:FLUSHING
Mailing Address - State:NY
Mailing Address - Zip Code:11354-3526
Mailing Address - Country:US
Mailing Address - Phone:347-256-7344
Mailing Address - Fax:
Practice Address - Street 1:13955 35TH AVE
Practice Address - Street 2:6F
Practice Address - City:FLUSHING
Practice Address - State:NY
Practice Address - Zip Code:11354-3526
Practice Address - Country:US
Practice Address - Phone:347-256-7344
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2015-03-31
Last Update Date:2015-03-31
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY018548363A00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363A00000XPhysician Assistants & Advanced Practice Nursing ProvidersPhysician Assistant