Healthcare Provider Details

I. General information

NPI: 1053879379
Provider Name (Legal Business Name): AHMAD BASSEM NASHIF PA
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 03/05/2019
Last Update Date: 08/20/2025
Certification Date: 08/20/2025
Deactivation Date:
Reactivation Date:

III. Provider practice location address

4 PRINCESS RD STE 206
LAWRENCEVILLE NJ
08648-2322
US

IV. Provider business mailing address

5 BRIANNA CT
HAMILTON NJ
08619-1400
US

V. Phone/Fax

Practice location:
  • Phone: 609-482-3701
  • Fax:
Mailing address:
  • Phone: 609-789-7385
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code363AM0700X
TaxonomyMedical Physician Assistant
License Number25MP00515900
License Number StateNJ

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: