Healthcare Provider Details

I. General information

NPI: 1649687211
Provider Name (Legal Business Name): BAO-NGOC NASRI MD
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 07/16/2014
Last Update Date: 12/03/2025
Certification Date: 12/03/2025
Deactivation Date:
Reactivation Date:

III. Provider practice location address

55 MEADOWLANDS PKWY
SECAUCUS NJ
07094-2977
US

IV. Provider business mailing address

296 MILLBURN AVE APT 201
MILLBURN NJ
07041-1648
US

V. Phone/Fax

Practice location:
  • Phone: 201-392-3100
  • Fax:
Mailing address:
  • Phone: 347-703-0927
  • Fax: 973-657-5083

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code208600000X
TaxonomySurgery Physician
License Number25MA11473800
License Number StateNJ

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: