=====================================================
General NPI Number Information
=====================================================
NPI Number | 1033862016
-----------------------------------------------------
Entity Type | Organization
-----------------------------------------------------
Legal Business Name | NAZAIRE MEDICAL GROUP
-----------------------------------------------------
=====================================================
Dates
=====================================================
Enumeration Date | 01/31/2022
-----------------------------------------------------
Last Update Date | 04/19/2023
-----------------------------------------------------
=====================================================
Provider Practice Location Address
=====================================================
Address Line | 283 MONMOUTH RD
-----------------------------------------------------
City | FREEHOLD
-----------------------------------------------------
State | NJ
-----------------------------------------------------
Zip | 07728-7933
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 732-898-2953
-----------------------------------------------------
Fax | 732-353-0203
-----------------------------------------------------
=====================================================
Provider Business Mailing Address
=====================================================
Address Line | 283 MONMOUTH RD
-----------------------------------------------------
City | FREEHOLD
-----------------------------------------------------
State | NJ
-----------------------------------------------------
Zip | 07728-7933
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 732-898-2953
-----------------------------------------------------
Fax |
-----------------------------------------------------
=====================================================
Authorized Official
=====================================================
Title or Position | FOUNDER & CEO/NURSE PRACTITIONER
-----------------------------------------------------
Name | MARTINE NAZAIRE
-----------------------------------------------------
Credential | MSN-RN, APN-C, CWS
-----------------------------------------------------
Telephone | 732-898-2953
-----------------------------------------------------
=====================================================
Scope of Practice (Provider's specialty)
=====================================================
Taxonomy #1
-----------------------------------------------------
Taxonomy Code | 363L00000X
-----------------------------------------------------
Taxonomy Name | Nurse Practitioner
-----------------------------------------------------
License Number |
-----------------------------------------------------
License Number State |
-----------------------------------------------------