Provider Demographics
NPI:1447850722
Name:NASSAR, JOSEPHINE K
Entity type:Individual
Prefix:
First Name:JOSEPHINE
Middle Name:K
Last Name:NASSAR
Suffix:
Gender:F
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:129 NEWHALL ST
Mailing Address - Street 2:
Mailing Address - City:NEW HAVEN
Mailing Address - State:CT
Mailing Address - Zip Code:06511-1909
Mailing Address - Country:US
Mailing Address - Phone:914-228-5726
Mailing Address - Fax:
Practice Address - Street 1:129 NEWHALL ST
Practice Address - Street 2:
Practice Address - City:NEW HAVEN
Practice Address - State:CT
Practice Address - Zip Code:06511-1909
Practice Address - Country:US
Practice Address - Phone:914-228-5726
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2020-10-27
Last Update Date:2020-10-27
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CT0001765376J00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes376J00000XNursing Service Related ProvidersHomemaker