Healthcare Provider Details

I. General information

NPI: 1548965064
Provider Name (Legal Business Name): HAMZEH B NASR MD
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 04/03/2023
Last Update Date: 06/01/2026
Certification Date: 06/01/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

300 2ND AVE
LONG BRANCH NJ
07740-6395
US

IV. Provider business mailing address

300 2ND AVE
LONG BRANCH NJ
07740-6395
US

V. Phone/Fax

Practice location:
  • Phone: 650-770-6662
  • Fax:
Mailing address:
  • Phone: 650-770-6662
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code207R00000X
TaxonomyInternal Medicine Physician
License Number25MA13056800
License Number StateNJ

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: