MEDICARE: ISLAM NASR PT

Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

#	Taxonomy Code	Taxonomy	License Number	License Number State
1	225100000X	Physical Therapist	040678	NY

General Provider Information

NPI Number	:	1598213910
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	ISLAM NASR PT

Provider Business Mailing Address
First Line	:	19 GRIGGS DR
Second Line	:
City	:	DAYTON
State	:	NJ
Zip	:	08810-1401
Country	:	US
Telephone Number	:	929-253-1233
Fax Number	:

Provider Business Practice Location Address
First Line	:	68 BELMONT AVE
Second Line	:
City	:	BROOKLYN
State	:	NY
Zip	:	11212-6705
Country	:	US
Telephone Number	:	929-253-1233
Fax Number	:

Authorized Official
Title or Position	:
Name	:
Credential	:
Telephone Number	:

Provider Enumeration Date	:	09/14/2016
Last Update Date	:	03/11/2022

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