Provider Demographics
NPI:1427224310
Name:FRED J NAHAS MD PA
Entity Type:Organization
Organization Name:FRED J NAHAS MD PA
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PRESIDENT
Authorized Official - Prefix:DR
Authorized Official - First Name:FREDERICK
Authorized Official - Middle Name:JOHN
Authorized Official - Last Name:NAHAS
Authorized Official - Suffix:II
Authorized Official - Credentials:MD
Authorized Official - Phone:609-653-1010
Mailing Address - Street 1:631 SHORE RD
Mailing Address - Street 2:
Mailing Address - City:SOMERS POINT
Mailing Address - State:NJ
Mailing Address - Zip Code:08244-2483
Mailing Address - Country:US
Mailing Address - Phone:609-653-1010
Mailing Address - Fax:609-653-9591
Practice Address - Street 1:631 SHORE RD
Practice Address - Street 2:
Practice Address - City:SOMERS POINT
Practice Address - State:NJ
Practice Address - Zip Code:08244-2483
Practice Address - Country:US
Practice Address - Phone:609-653-1010
Practice Address - Fax:609-653-9591
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2008-05-01
Last Update Date:2008-05-01
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NJ25MA3497900208600000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes208600000XAllopathic & Osteopathic PhysiciansSurgeryGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
NJ2992906Medicaid
NJ154481Medicare PIN
NJ2992906Medicaid