Provider Demographics
NPI:1548461015
Name:GEORGE M. NASSOOR, D.P.M., LLC
Entity type:Organization
Organization Name:GEORGE M. NASSOOR, D.P.M., LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PODIATRIST
Authorized Official - Prefix:DR
Authorized Official - First Name:GEORGE
Authorized Official - Middle Name:MICHAEL
Authorized Official - Last Name:NASSOOR
Authorized Official - Suffix:
Authorized Official - Credentials:DPM
Authorized Official - Phone:908-454-3770
Mailing Address - Street 1:430 MEMORIAL PKWY
Mailing Address - Street 2:
Mailing Address - City:PHILLIPSBURG
Mailing Address - State:NJ
Mailing Address - Zip Code:08865-1573
Mailing Address - Country:US
Mailing Address - Phone:908-454-3770
Mailing Address - Fax:908-454-7822
Practice Address - Street 1:430 MEMORIAL PKWY
Practice Address - Street 2:
Practice Address - City:PHILLIPSBURG
Practice Address - State:NJ
Practice Address - Zip Code:08865-1573
Practice Address - Country:US
Practice Address - Phone:908-454-3770
Practice Address - Fax:908-454-7822
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2007-05-30
Last Update Date:2008-07-03
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NJMD01279213ES0131X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes213ES0131XPodiatric Medicine & Surgery Service ProvidersPodiatristFoot SurgeryGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
PA02698600OtherCAPITAL BLUE CROSS
NJ2346476000OtherAMERIHEALTH
NJ=========OtherUNITED HEALTHCARE
NJ=========OtherCIGNA
NJ2346476000OtherAMERIHEALTH
NJ=========OtherOXFORD
NJNA530224Medicare ID - Type UnspecifiedMEDICARE
NJT30266Medicare UPIN
NJ=========OtherOXFORD