Provider Demographics
NPI:1518147370
Name:NASSER E BORAI MD LLC
Entity Type:Organization
Organization Name:NASSER E BORAI MD LLC
Other - Org Name:NASSER E. BORAI, MD
Other - Org Type:Former Legal Business Name
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:DR
Authorized Official - First Name:NASSER
Authorized Official - Middle Name:E
Authorized Official - Last Name:BORAI
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:609-404-9966
Mailing Address - Street 1:54 W JIMMIE LEEDS RD
Mailing Address - Street 2:SUITES 11 & 12
Mailing Address - City:GALLOWAY
Mailing Address - State:NJ
Mailing Address - Zip Code:08205-9401
Mailing Address - Country:US
Mailing Address - Phone:609-404-9966
Mailing Address - Fax:609-404-9967
Practice Address - Street 1:54 W JIMMIE LEEDS RD
Practice Address - Street 2:SUITES 11 & 12
Practice Address - City:GALLOWAY
Practice Address - State:NJ
Practice Address - Zip Code:08205-9401
Practice Address - Country:US
Practice Address - Phone:609-404-9966
Practice Address - Fax:609-404-9967
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2007-11-09
Last Update Date:2013-02-19
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NJ25MA05533500207RH0003X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes207RH0003XAllopathic & Osteopathic PhysiciansInternal MedicineHematology & OncologyGroup - Multi-Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
NJ6552200Medicaid
5178380001OtherHEALTHNOW NY/DMERC A
830007154OtherPALMETTO GBA/RR MEDICARE
830007154OtherPALMETTO GBA/RR MEDICARE