Provider Demographics
NPI:1356595292
Name:NASRINE A. SHADPOOR O.D.P.A.
Entity type:Organization
Organization Name:NASRINE A. SHADPOOR O.D.P.A.
Other - Org Name:<UNAVAIL>
Other - Org Type:
Authorized Official - Title/Position:PRESIDENT
Authorized Official - Prefix:DR
Authorized Official - First Name:NASRINE
Authorized Official - Middle Name:A
Authorized Official - Last Name:SHADPOOR
Authorized Official - Suffix:
Authorized Official - Credentials:OD
Authorized Official - Phone:908-781-7707
Mailing Address - Street 1:452-A ROUTE 206 NORTH
Mailing Address - Street 2:
Mailing Address - City:BEDMINSTER
Mailing Address - State:NJ
Mailing Address - Zip Code:07921-1528
Mailing Address - Country:US
Mailing Address - Phone:908-781-7707
Mailing Address - Fax:908-781-7708
Practice Address - Street 1:452-A ROUTE 206
Practice Address - Street 2:
Practice Address - City:BEDMINSTER
Practice Address - State:NJ
Practice Address - Zip Code:07921-1528
Practice Address - Country:US
Practice Address - Phone:908-781-7707
Practice Address - Fax:908-781-7708
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2008-11-05
Last Update Date:2008-11-05
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NJ5334302F00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes302F00000XManaged Care OrganizationsExclusive Provider Organization
Provider Identifiers
StateIdentifier IDID TypeIssuer
NJU51887Medicare UPIN