Provider Demographics
NPI:1275679805
Name:ANI, NASSER (MD)
Entity Type:Individual
Prefix:DR
First Name:NASSER
Middle Name:
Last Name:ANI
Suffix:
Gender:M
Credentials:MD
Other - Prefix:
Other - First Name:
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Other - Last Name:
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Other - Credentials:
Mailing Address - Street 1:1 BETHANY RD
Mailing Address - Street 2:BLDG 2 STE 21
Mailing Address - City:HAZLET
Mailing Address - State:NJ
Mailing Address - Zip Code:07730-1663
Mailing Address - Country:US
Mailing Address - Phone:732-264-8282
Mailing Address - Fax:732-264-8131
Practice Address - Street 1:1 BETHANY RD
Practice Address - Street 2:BLDG 2 STE 21
Practice Address - City:HAZLET
Practice Address - State:NJ
Practice Address - Zip Code:07730-1663
Practice Address - Country:US
Practice Address - Phone:732-264-8282
Practice Address - Fax:732-264-8131
Is Sole Proprietor?:No
Enumeration Date:2007-01-30
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
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Provider Licenses
StateLicense IDTaxonomies
NJMA547174207X00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207X00000XAllopathic & Osteopathic PhysiciansOrthopaedic Surgery
Provider Identifiers
StateIdentifier IDID TypeIssuer
NJE547174Medicare UPIN