Provider Demographics
NPI:1659332591
Name:NASR, JOHN T (MD)
Entity Type:Individual
Prefix:MR
First Name:JOHN
Middle Name:T
Last Name:NASR
Suffix:
Gender:M
Credentials:MD
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Mailing Address - Street 1:1200 EAST RIDGEWOOD AVE
Mailing Address - Street 2:EAST WING - 2ND FLOOR
Mailing Address - City:RIDGEWOOD
Mailing Address - State:NJ
Mailing Address - Zip Code:07450
Mailing Address - Country:US
Mailing Address - Phone:201-444-0868
Mailing Address - Fax:201-493-0797
Practice Address - Street 1:1200 EAST RIDGEWOOD AVE
Practice Address - Street 2:EAST WING - 2ND FLOOR
Practice Address - City:RIDGEWOOD
Practice Address - State:NJ
Practice Address - Zip Code:07450
Practice Address - Country:US
Practice Address - Phone:201-444-0868
Practice Address - Fax:201-493-0797
Is Sole Proprietor?:No
Enumeration Date:2006-03-30
Last Update Date:2023-07-19
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Deactivation Code:
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Provider Licenses
StateLicense IDTaxonomies
NJMA710812084N0400X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes2084N0400XAllopathic & Osteopathic PhysiciansPsychiatry & NeurologyNeurology
Provider Identifiers
StateIdentifier IDID TypeIssuer
NJ8426601Medicaid
NJ8426601Medicaid
043397ADPMedicare PIN
043397Medicare ID - Type Unspecified