Provider Demographics
NPI:1790038628
Name:NASSIM MEDICAL PC
Entity Type:Organization
Organization Name:NASSIM MEDICAL PC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER/MEDICAL DIRECTOR
Authorized Official - Prefix:DR
Authorized Official - First Name:ROLAND
Authorized Official - Middle Name:
Authorized Official - Last Name:NASSIM
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:516-773-3942
Mailing Address - Street 1:1000 NORTHERN BLVD STE 375
Mailing Address - Street 2:
Mailing Address - City:GREAT NECK
Mailing Address - State:NY
Mailing Address - Zip Code:11021-5312
Mailing Address - Country:US
Mailing Address - Phone:516-773-3942
Mailing Address - Fax:516-734-0172
Practice Address - Street 1:1000 NORTHERN BLVD STE 375
Practice Address - Street 2:
Practice Address - City:GREAT NECK
Practice Address - State:NY
Practice Address - Zip Code:11021-5312
Practice Address - Country:US
Practice Address - Phone:516-773-3942
Practice Address - Fax:516-734-0172
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2012-10-16
Last Update Date:2012-10-16
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes207R00000XAllopathic & Osteopathic PhysiciansInternal MedicineGroup - Multi-Specialty