Provider Demographics
NPI:1114247699
Name:NASSER, MOHAMED (PT)
Entity Type:Individual
Prefix:
First Name:MOHAMED
Middle Name:
Last Name:NASSER
Suffix:
Gender:M
Credentials:PT
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:918 SOUTH AVE W FL 1
Mailing Address - Street 2:
Mailing Address - City:WESTFIELD
Mailing Address - State:NJ
Mailing Address - Zip Code:07090-1415
Mailing Address - Country:US
Mailing Address - Phone:855-633-3786
Mailing Address - Fax:
Practice Address - Street 1:918 SOUTH AVE W FL 1
Practice Address - Street 2:
Practice Address - City:WESTFIELD
Practice Address - State:NJ
Practice Address - Zip Code:07090-1415
Practice Address - Country:US
Practice Address - Phone:855-633-3786
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2010-06-07
Last Update Date:2020-09-16
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
261QP2000X
NJ40QA01103700225100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225100000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical Therapist
No261QP2000XAmbulatory Health Care FacilitiesClinic/CenterPhysical Therapy