1043284524 NPI number — PASQUALE F NESTICO MD

Table of content: PASQUALE F NESTICO MD (NPI 1043284524)

General

This information contains only most important part of the NPI data, for complete information, including NPI referencing materials please refer to 1043284524 NPI number — PASQUALE F NESTICO MD

Organization/Personal Information

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

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:
1043284524
Entity Type Code:
Individual
Replacement NPI:
Last Update Date:
07/13/2023
NPI Deactivation Reason Code:
NPI Deactivation Date:
NPI Reactivation Date:

Provider's Business Mailing Address

Provider First Line Business Mailing Address:
207 N BROAD ST
Provider Second Line Business Mailing Address:
3RD FLR.
Provider Business Mailing Address City Name:
PHILADELPHIA
Provider Business Mailing Address State Name:
PA
Provider Business Mailing Address Postal Code:
19107-1500
Provider Business Mailing Address Country Code:
US
Provider Business Mailing Address Telephone Number:
215-389-3890
Provider Business Mailing Address Fax Number:
215-551-0368

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
1809 W OREGON AVE
Provider Second Line Business Practice Location Address:
FLR 1
Provider Business Practice Location Address City Name:
PHILADELPHIA
Provider Business Practice Location Address State Name:
PA
Provider Business Practice Location Address Postal Code:
19145
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
215-389-3890
Provider Business Practice Location Address Fax Number:
215-551-0368
Provider Enumeration Date:
02/14/2006

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: 207RC0000X , with the licence number:  MD025234E , registered in the state of PA ; information, associated with the NPI states the following Primary Taxonomy Switch: "Y" .

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

  • Identifier: 000872540 , issued by the state of ( PA ) . This identifiers is of the category "MEDICAID".




Copyright © 2007-2024 www.npivalidator.com