Nissley, Frederick P

Nissley, Frederick P is an individual health care provider with primary practice located at 3401 N Broad St Bsmt Rock Pavilion, Philadelphia PA 19140-5103. He recently has only one registered license in Allopathic & Osteopathic Physicians / Physical Medicine & Rehabilitation, which is considered as his primary health care specialty. Nissley, Frederick P can be contacted via phone (215) 707-3646.

Contact Information

Primary practice address
3401 N Broad St Bsmt Rock Pavilion Philadelphia PA 19140-5103
Phone: (215) 707-3646
Fax: (215) 707-6594
Website:
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Health care specialties

SpecialtyCodeLicense #State
Allopathic & Osteopathic Physicians / Physical Medicine & Rehabilitation 208100000X 0S009450L Pennsylvania

Profile Details

NPI number 1922096122
LBN Legal business name Nissley, Frederick P
Credentials Doctor of Osteopathy (DO)
Entity Individual
Sole proprietor 1 No
Enumeration date Oct 11th, 2005
Last updated Jan 22nd, 2010 - about 16 years ago

1 A sole proprietor/sole proprietorship is an individual, and in that capacity, is qualified for a solitary NPI number. The sole proprietor have to apply for the NPI number using his or her own particular Social Security Number (SSN), instead of Employer Identification Number (EIN) regardless of whether he/she has an EIN.

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Identifiers

StateTypeNumberIssuer
All States NPI 1922096122 NPPES
Pennsylvania MEDICAID 0018104530004

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