Provider Demographics
NPI:1447250261
Name:NAZAR, JEFFREY (DC)
Entity type:Individual
Prefix:DR
First Name:JEFFREY
Middle Name:
Last Name:NAZAR
Suffix:
Gender:M
Credentials:DC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:PO BOX 596
Mailing Address - Street 2:
Mailing Address - City:AQUEBOGUE
Mailing Address - State:NY
Mailing Address - Zip Code:11931-0596
Mailing Address - Country:US
Mailing Address - Phone:631-722-4425
Mailing Address - Fax:631-722-4480
Practice Address - Street 1:487 MAIN ROAD
Practice Address - Street 2:A & B
Practice Address - City:AQUEBOGUE
Practice Address - State:NY
Practice Address - Zip Code:11931-0596
Practice Address - Country:US
Practice Address - Phone:631-722-4425
Practice Address - Fax:631-722-4480
Is Sole Proprietor?:Yes
Enumeration Date:2005-07-22
Last Update Date:2010-12-21
Deactivation Date:2006-03-21
Deactivation Code:
Reactivation Date:2006-03-28
Provider Licenses
StateLicense IDTaxonomies
NYX007763-1111N00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes111N00000XChiropractic ProvidersChiropractor