Provider Demographics
NPI:1740230051
Name:WASTI, NAILA (MD)
Entity Type:Individual
Prefix:DR
First Name:NAILA
Middle Name:
Last Name:WASTI
Suffix:
Gender:F
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:4056 QUAKERBRIDGE RD STE 101
Mailing Address - Street 2:
Mailing Address - City:LAWRENCEVILLE
Mailing Address - State:NJ
Mailing Address - Zip Code:08648-4779
Mailing Address - Country:US
Mailing Address - Phone:609-528-9150
Mailing Address - Fax:609-528-9151
Practice Address - Street 1:4056 QUAKERBRIDGE RD STE 101
Practice Address - Street 2:
Practice Address - City:LAWRENCEVILLE
Practice Address - State:NJ
Practice Address - Zip Code:08648-4779
Practice Address - Country:US
Practice Address - Phone:609-528-9150
Practice Address - Fax:609-528-9151
Is Sole Proprietor?:No
Enumeration Date:2006-05-10
Last Update Date:2021-04-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NJ25MA05947700207R00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207R00000XAllopathic & Osteopathic PhysiciansInternal Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
NJ849951ZF8VOtherPTAN GROUP #
NJ6868207Medicaid
NJ849951ZF8VOtherPTAN GROUP #
NJG24007Medicare UPIN