=====================================================
General NPI Number Information
=====================================================
NPI Number | 1649687211
-----------------------------------------------------
Entity Type | Individual
-----------------------------------------------------
Provider Name | BAO-NGOC NASRI MD
-----------------------------------------------------
Gender | Female
-----------------------------------------------------
=====================================================
Dates
=====================================================
Enumeration Date | 07/16/2014
-----------------------------------------------------
Last Update Date | 12/03/2025
-----------------------------------------------------
=====================================================
Provider Practice Location Address
=====================================================
Address Line | 55 MEADOWLANDS PKWY
-----------------------------------------------------
City | SECAUCUS
-----------------------------------------------------
State | NJ
-----------------------------------------------------
Zip | 07094-2977
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 201-392-3100
-----------------------------------------------------
Fax |
-----------------------------------------------------
=====================================================
Provider Business Mailing Address
=====================================================
Address Line | 296 MILLBURN AVE APT 201
-----------------------------------------------------
City | MILLBURN
-----------------------------------------------------
State | NJ
-----------------------------------------------------
Zip | 07041-1648
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 347-703-0927
-----------------------------------------------------
Fax | 973-657-5083
-----------------------------------------------------
=====================================================
Authorized Official
=====================================================
Title or Position |
-----------------------------------------------------
Name |
-----------------------------------------------------
Credential |
-----------------------------------------------------
Telephone |
-----------------------------------------------------
=====================================================
Scope of Practice (Provider's specialty)
=====================================================
Taxonomy #1
-----------------------------------------------------
Taxonomy Code | 208600000X
-----------------------------------------------------
Taxonomy Name | Surgery Physician
-----------------------------------------------------
License Number | 25MA11473800
-----------------------------------------------------
License Number State | NJ
-----------------------------------------------------