Healthcare Provider Details

I. General information

NPI: 1770015737
Provider Name (Legal Business Name): DINA NASSAR MD
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 03/29/2017
Last Update Date: 01/28/2026
Certification Date: 01/28/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

111 E 210TH ST
BRONX NY
10467-2401
US

IV. Provider business mailing address

16 ACORN DR
SKILLMAN NJ
08558-1635
US

V. Phone/Fax

Practice location:
  • Phone: 718-484-5135
  • Fax:
Mailing address:
  • Phone:
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code208000000X
TaxonomyPediatrics Physician
License NumberMD470871
License Number StatePA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: