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
StateLicense IDTaxonomies
NJ25MA07200000207R00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207R00000XAllopathic & Osteopathic PhysiciansInternal Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
NJ1K6964OtherHEALTHNET PROVIDER ID
NJ8574804Medicaid
NJP2481444OtherOXFORD HEALTH PLANS
NJ8574804Medicaid
NJ1K6964OtherHEALTHNET PROVIDER ID