1336631860 NPI number — AMARA NASIR MD

Table of content: AMARA NASIR MD (NPI 1336631860)

General

This information contains only most important part of the NPI data, for complete information, including NPI referencing materials please refer to 1336631860 NPI number — AMARA NASIR MD

Organization/Personal Information

Employer Identification Number (EIN):
Provider Organization Name:
Provider Last Name:
NASIR
Provider First Name:
AMARA
Provider Middle Name:
Provider Name Prefix Text:
Provider Name Suffix Text:
Provider Credential Text:
MD
Provider Gender Code:
F

Provider's Other Name Information

Provider Other Organization Name:
Provider Other Organization Name Type Code:
Provider Other Last Name:
Provider Other First Name:
Provider Other Middle Name:
Provider Other Name Prefix Text:
Provider Other Name Suffix Text:
Provider Other Credential Text:
Provider Other Last Name Type Code:

NPI Number Information

NPI Number:
1336631860
Entity Type Code:
Individual
Replacement NPI:
Last Update Date:
03/02/2024
NPI Deactivation Reason Code:
NPI Deactivation Date:
NPI Reactivation Date:

Provider's Business Mailing Address

Provider First Line Business Mailing Address:
1910 SOUTH RD
Provider Second Line Business Mailing Address:
Provider Business Mailing Address City Name:
POUGHKEEPSIE
Provider Business Mailing Address State Name:
NY
Provider Business Mailing Address Postal Code:
12601-6053
Provider Business Mailing Address Country Code:
US
Provider Business Mailing Address Telephone Number:
845-454-0120
Provider Business Mailing Address Fax Number:
845-686-9006

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
3141 ROUTE 9W STE 100
Provider Second Line Business Practice Location Address:
Provider Business Practice Location Address City Name:
NEW WINDSOR
Provider Business Practice Location Address State Name:
NY
Provider Business Practice Location Address Postal Code:
12553-6724
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
845-534-5768
Provider Business Practice Location Address Fax Number:
Provider Enumeration Date:
05/31/2018

Additional Information

			
		

Authorized Official

Authorized Official Last Name:
Authorized Official First Name:
Authorized Official Middle Name:
Authorized Official Title or Position:
Authorized Official Telephone Number:

Provider Taxonomy Codes

  • Taxonomy code: 2081P2900X , with the licence number:  326298 , registered in the state of NY ; information, associated with the NPI states the following Primary Taxonomy Switch: "N" .
  • Taxonomy code: 208VP0000X , with the licence number: 326298 , registered in the state of NY ; information, associated with the NPI states the following Primary Taxonomy Switch: "Y" .

Other Provider's Identifiers (legacy, non-NPI)