Provider Demographics
NPI:1457547374
Name:NASR, KHALED NABIL (DPTMSPT)
Entity Type:Individual
Prefix:DR
First Name:KHALED
Middle Name:NABIL
Last Name:NASR
Suffix:
Gender:M
Credentials:DPTMSPT
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1368 ACADEMY LN
Mailing Address - Street 2:
Mailing Address - City:TEANECK
Mailing Address - State:NJ
Mailing Address - Zip Code:07666-2112
Mailing Address - Country:US
Mailing Address - Phone:347-400-7698
Mailing Address - Fax:
Practice Address - Street 1:780 8TH AVE STE 201
Practice Address - Street 2:
Practice Address - City:NEW YORK
Practice Address - State:NY
Practice Address - Zip Code:10036-7000
Practice Address - Country:US
Practice Address - Phone:212-300-7069
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2007-09-25
Last Update Date:2015-09-03
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY62 0261492251X0800X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes2251X0800XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical TherapistOrthopedic
Provider Identifiers
StateIdentifier IDID TypeIssuer
NY133870146Medicare PIN