NPI Code Detail JSON Logo

1659877090 NPI number — MAHDY ALI NASSAR

NPI Number: 1659877090
Health Care Provider/Practitioner: MAHDY ALI NASSAR

Information about “1659877090” NPI (MAHDY ALI NASSAR) exists in 1659877090 in HTML format HTML  |  1659877090 in plain Text format TXT  |  1659877090 in PDF (Portable Document Format) PDF  |  1659877090 in an XML format XML  formats.

NPI Number : 1659877090 – JSON Data Format

                
{
  "Npi": {
    "NPI": "1659877090",
    "EntityType": "Individual",
    "ReplacementNPI": null,
    "EIN": null,
    "IsSoleProprietor": "Y",
    "IsOrgSubpart": null,
    "ParentOrgLBN": null,
    "ParentOrgTIN": null,
    "OrgName": null,
    "LastName": "NASSAR",
    "FirstName": "MAHDY",
    "MiddleName": "ALI",
    "NamePrefix": null,
    "NameSuffix": null,
    "Credential": null,
    "OtherOrgName": null,
    "OtherOrgNameTypeCode": null,
    "OtherLastName": null,
    "OtherFirstName": null,
    "OtherMiddleName": null,
    "OtherNamePrefix": null,
    "OtherNameSuffix": null,
    "OtherCredential": null,
    "OtherLastNameTypeCode": null,
    "FirstLineMailingAddress": "3901 CHRYSLER SERVICE DRIVE",
    "SecondLineMailingAddress": "SUITE 5A",
    "MailingAddressCityName": "DETROIT",
    "MailingAddressStateName": "MI",
    "MailingAddressPostalCode": "48201",
    "MailingAddressCountryCode": "US",
    "MailingAddressTelephoneNumber": "313-220-9037",
    "MailingAddressFaxNumber": null,
    "FirstLinePracticeLocationAddress": "3901 CHRYSLER SERVICE DRIVE",
    "SecondLinePracticeLocationAddress": "SUITE 5A",
    "PracticeLocationAddressCityName": "DETROIT",
    "PracticeLocationAddressStateName": "MI",
    "PracticeLocationAddressPostalCode": "48201",
    "PracticeLocationAddressCountryCode": "US",
    "PracticeLocationAddressTelephoneNumber": "313-577-5283",
    "PracticeLocationAddressFaxNumber": null,
    "EnumerationDate": "04/04/2018",
    "LastUpdateDate": "04/09/2021",
    "NPIDeactivationReasonCode": null,
    "NPIDeactivationReason": null,
    "NPIDeactivationDate": null,
    "NPIReactivationDate": null,
    "GenderCode": "M",
    "Gender": "Male",
    "AuthorizedOfficialLastName": null,
    "AuthorizedOfficialFirstName": null,
    "AuthorizedOfficialMiddleName": null,
    "AuthorizedOfficialTitle": null,
    "AuthorizedOfficialNamePrefix": null,
    "AuthorizedOfficialNameSuffix": null,
    "AuthorizedOfficialCredential": null,
    "AuthorizedOfficialTelephoneNumber": null,
    "Taxonomies": {
      "Taxonomy": [
        {
          "TaxonomyCode": "2084P0800X",
          "TaxonomyName": "Psychiatry Physician",
          "LicenseNumber": "5101025934",
          "LicenseNumberStateCode": "MI",
          "PrimaryTaxonomySwitch": "Y"
        },
        {
          "TaxonomyCode": "390200000X",
          "TaxonomyName": "Student in an Organized Health Care Education/Training Program",
          "LicenseNumber": null,
          "LicenseNumberStateCode": null,
          "PrimaryTaxonomySwitch": "N"
        }
      ]
    },
    "HealthcareProviderTaxonomyGroups": {
      "HealthcareProviderTaxonomyGroup": {
        "HealthcareProviderTaxonomyGroupName": "193400000X SINGLE SPECIALTY  GROUP",
        "HealthcareProviderTaxonomyGroupDescription": "Single Specialty Group - A business group of one or more individual practitioners, all of who practice with the same area of specialization."
      }
    }
  }
}
                
            

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