Provider Demographics
NPI:1710656558
Name:NASRULLAH, ATIF
Entity Type:Individual
Prefix:
First Name:ATIF
Middle Name:
Last Name:NASRULLAH
Suffix:
Gender:M
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:5015 WASHINGTON AVE, THE WRIGHT CENTER
Mailing Address - Street 2:501 S. WASHINGTON AVE
Mailing Address - City:SCRANTON
Mailing Address - State:PA
Mailing Address - Zip Code:18505
Mailing Address - Country:US
Mailing Address - Phone:570-507-3027
Mailing Address - Fax:570-343-4800
Practice Address - Street 1:501 S WASHINGTON AVE, THE WRIGHT CENTER
Practice Address - Street 2:
Practice Address - City:SCRANTON
Practice Address - State:PA
Practice Address - Zip Code:18505
Practice Address - Country:US
Practice Address - Phone:570-507-3027
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2021-09-07
Last Update Date:2022-12-09
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
PAMT224569390200000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes390200000XStudent, Health CareStudent in an Organized Health Care Education/Training Program