Healthcare Provider Details

I. General information

NPI: 1841262995
Provider Name (Legal Business Name): NABIL JACIR MD
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 02/03/2006
Last Update Date: 08/01/2011
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

99 BEAUVOIR AVE
SUMMIT NJ
07901-3533
US

IV. Provider business mailing address

PO BOX 416457
BOSTON MA
02241-6457
US

V. Phone/Fax

Practice location:
  • Phone: 973-522-3523
  • Fax: 973-522-3525
Mailing address:
  • Phone: 973-971-7187
  • Fax: 973-290-8320

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code2086S0120X
TaxonomyPediatric Surgery Physician
License Number25MA06571800
License Number StateNJ

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: