Healthcare Provider Details

I. General information

NPI: 1710823471
Provider Name (Legal Business Name): NASSIM ISMAIL AMRO RN
Entity Type: Individual
Gender: Male
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 04/27/2026
Last Update Date: 04/27/2026
Certification Date: 04/26/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

703 MAIN ST
PATERSON NJ
07503-2621
US

IV. Provider business mailing address

37 CHATHAM TER
CLIFTON NJ
07013-3903
US

V. Phone/Fax

Practice location:
  • Phone: 201-838-3148
  • Fax:
Mailing address:
  • Phone: 201-838-3148
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code390200000X
TaxonomyStudent in an Organized Health Care Education/Training Program
License Number
License Number State
# 2
Primary TaxonomyY
Taxonomy Code163WC0200X
TaxonomyCritical Care Medicine Registered Nurse
License Number26NR24738500
License Number StateNJ

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: