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General NPI Number Information
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NPI Number | 1295491926
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Entity Type | Individual
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Provider Name | RANDA NASSAR PA-C
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Gender | Female
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Dates
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Enumeration Date | 11/17/2021
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Last Update Date | 09/15/2023
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Provider Practice Location Address
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Address Line | 440 MAMARONECK AVE STE 505
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City | HARRISON
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State | NY
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Zip | 10528-2432
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Country | US
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Telephone | 440-462-1400
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Fax |
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Provider Business Mailing Address
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Address Line | 440 MAMARONECK AVE STE 505
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City | HARRISON
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State | NY
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Zip | 10528-2433
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Country | US
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Telephone | 646-240-2091
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Fax |
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Authorized Official
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Title or Position |
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Name |
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Credential |
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Telephone |
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 363AM0700X
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Taxonomy Name | Medical Physician Assistant
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License Number | 026825
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License Number State | NY
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