Nissley, Jay Marlin

Nissley, Jay Marlin is an individual health care provider with primary practice located at 55 Medical Park Dr , Lewisburg PA 17837-6343. He recently has only one registered license in Allopathic & Osteopathic Physicians / Pediatrics, which is considered as his primary health care specialty. Nissley, Jay Marlin can be contacted via phone (570) 523-3264.

Contact Information

Primary practice address
55 Medical Park Dr Lewisburg PA 17837-6343
Fax: (570) 523-3465
Website:

Health care specialties

SpecialtyCodeLicense #State
Allopathic & Osteopathic Physicians / Pediatrics 208000000X MD011004E Pennsylvania

Profile Details

NPI number 1215924345
LBN Legal business name Nissley, Jay Marlin
Credentials Doctor of Medicine (MD)
Entity Individual
Sole proprietor 1 No
Enumeration date Oct 4th, 2005
Last updated Nov 10th, 2011 - about 15 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 1215924345 NPPES
Pennsylvania MEDICAID 0008831050003

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