Provider Demographics
NPI:1114352150
Name:ABDELLATIF, NASIR
Entity Type:Individual
Prefix:DR
First Name:NASIR
Middle Name:
Last Name:ABDELLATIF
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 1:701 FRANK E RODGERS BLVD N
Mailing Address - Street 2:STE.5
Mailing Address - City:HARRISON
Mailing Address - State:NJ
Mailing Address - Zip Code:07029-2627
Mailing Address - Country:US
Mailing Address - Phone:973-483-5902
Mailing Address - Fax:973-483-0123
Practice Address - Street 1:701 FRANK E RODGERS BLVD N
Practice Address - Street 2:STE.5
Practice Address - City:HARRISON
Practice Address - State:NJ
Practice Address - Zip Code:07029-2627
Practice Address - Country:US
Practice Address - Phone:973-483-5902
Practice Address - Fax:973-483-0123
Is Sole Proprietor?:Yes
Enumeration Date:2013-09-10
Last Update Date:2013-09-10
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NJ18975122300000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes122300000XDental ProvidersDentist