Healthcare Provider Details

I. General information

NPI: 1306814900
Provider Name (Legal Business Name): DR. SHERIF A NASR
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 03/09/2006
Last Update Date: 06/01/2026
Certification Date: 06/01/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

25 RIVERSIDE DR STE 2
PINE BROOK NJ
07058-9391
US

IV. Provider business mailing address

25 RIVERSIDE DR STE 2
PINE BROOK NJ
07058-9391
US

V. Phone/Fax

Practice location:
  • Phone: 201-599-9044
  • Fax: 201-599-9066
Mailing address:
  • Phone: 201-599-9044
  • Fax: 201-599-9066

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code207ZP0102X
TaxonomyAnatomic Pathology & Clinical Pathology Physician
License Number25MA05880800
License Number StateNJ

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: