Provider Demographics
NPI:1467496703
Name:NASRA, MAGDY (MD)
Entity Type:Individual
Prefix:DR
First Name:MAGDY
Middle Name:
Last Name:NASRA
Suffix:
Gender:M
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:723 N BEERS ST
Mailing Address - Street 2:SUITE 2C
Mailing Address - City:HOLMDEL
Mailing Address - State:NJ
Mailing Address - Zip Code:07733-1517
Mailing Address - Country:US
Mailing Address - Phone:732-888-8255
Mailing Address - Fax:732-888-7682
Practice Address - Street 1:723 N BEERS ST
Practice Address - Street 2:SUITE 2C
Practice Address - City:HOLMDEL
Practice Address - State:NJ
Practice Address - Zip Code:07733-1517
Practice Address - Country:US
Practice Address - Phone:732-888-8255
Practice Address - Fax:732-888-7682
Is Sole Proprietor?:Yes
Enumeration Date:2006-06-16
Last Update Date:2010-01-14
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NJ25MA05934300207R00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207R00000XAllopathic & Osteopathic PhysiciansInternal Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
NJ6481507Medicaid
NJ6481507Medicaid
NJ616788NUFMedicare PIN