Healthcare Provider Details

I. General information

NPI: 1356595292
Provider Name (Legal Business Name): NASRINE A. SHADPOOR O.D.P.A.
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 11/05/2008
Last Update Date: 11/05/2008
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

452-A ROUTE 206
BEDMINSTER NJ
07921-1528
US

IV. Provider business mailing address

452-A ROUTE 206 NORTH
BEDMINSTER NJ
07921-1528
US

V. Phone/Fax

Practice location:
  • Phone: 908-781-7707
  • Fax: 908-781-7708
Mailing address:
  • Phone: 908-781-7707
  • Fax: 908-781-7708

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code302F00000X
TaxonomyExclusive Provider Organization
License Number5334
License Number StateNJ

VIII. Authorized Official

Name: DR. NASRINE A. SHADPOOR
Title or Position: PRESIDENT
Credential: O.D.
Phone: 908-781-7707