Provider Demographics
NPI: | 1942357595 |
---|---|
Name: | SAFA, NINA (MD) |
Entity Type: | Individual |
Prefix: | DR |
First Name: | NINA |
Middle Name: | |
Last Name: | SAFA |
Suffix: | |
Gender: | F |
Credentials: | MD |
Other - Prefix: | DR |
Other - First Name: | NAHEED |
Other - Middle Name: | |
Other - Last Name: | SAFABAKHSH |
Other - Suffix: | |
Other - Last Name Type: | Former Name |
Other - Credentials: | MD |
Mailing Address - Street 1: | 85 HARRISTOWN RD FL 2 |
Mailing Address - Street 2: | |
Mailing Address - City: | GLEN ROCK |
Mailing Address - State: | NJ |
Mailing Address - Zip Code: | 07452-3329 |
Mailing Address - Country: | US |
Mailing Address - Phone: | 201-855-8446 |
Mailing Address - Fax: | 201-444-0350 |
Practice Address - Street 1: | 14-01 BROADWAY STE 3 |
Practice Address - Street 2: | |
Practice Address - City: | FAIR LAWN |
Practice Address - State: | NJ |
Practice Address - Zip Code: | 07410-2008 |
Practice Address - Country: | US |
Practice Address - Phone: | 201-855-8455 |
Practice Address - Fax: | 201-855-8454 |
Is Sole Proprietor?: | No |
Enumeration Date: | 2007-01-05 |
Last Update Date: | 2018-05-11 |
Deactivation Date: | |
Deactivation Code: | |
Reactivation Date: |
Provider Licenses
State | License ID | Taxonomies |
---|---|---|
NJ | 25MA07200000 | 207R00000X |
Provider Taxonomies
Primary? | Code | Type | Classification | Specialization |
---|---|---|---|---|
Yes | 207R00000X | Allopathic & Osteopathic Physicians | Internal Medicine |
Provider Identifiers
State | Identifier ID | ID Type | Issuer |
---|---|---|---|
NJ | 1K6964 | Other | HEALTHNET PROVIDER ID |
NJ | 8574804 | Medicaid | |
NJ | P2481444 | Other | OXFORD HEALTH PLANS |
NJ | 8574804 | Medicaid | |
NJ | 1K6964 | Other | HEALTHNET PROVIDER ID |