Healthcare Provider Details

I. General information

NPI: 1811089576
Provider Name (Legal Business Name): GERALD NASTASIA JR. D.C.
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 09/29/2006
Last Update Date: 07/09/2007
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

70 NEW OCEAN ST
SWAMPSCOTT MA
01907-1831
US

IV. Provider business mailing address

2 JEAN DR
SEABROOK NH
03874-4196
US

V. Phone/Fax

Practice location:
  • Phone: 781-581-7300
  • Fax:
Mailing address:
  • Phone: 781-888-2419
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code111NX0800X
TaxonomyOrthopedic Chiropractor
License Number1524
License Number StateMA
# 2
Primary TaxonomyN
Taxonomy Code111NX0800X
TaxonomyOrthopedic Chiropractor
License Number2006022689
License Number StateMO

VII. Legacy identifiers

For crosswalk purposes, the following legacy (non-NPI) identifiers are available for this provider:

# 1
Identifier737865
Identifier TypeOTHER
Identifier StateMA
Identifier IssuerTUFTS
# 2
Identifier508030
Identifier TypeOTHER
Identifier StateMA
Identifier IssuerHCVM
# 3
IdentifierB20294501
Identifier TypeOTHER
Identifier StateMA
Identifier IssuerCIGNA
# 4
IdentifierY36064
Identifier TypeOTHER
Identifier StateMA
Identifier IssuerBLUECROSS OF MA
# 5
Identifier998114
Identifier TypeOTHER
Identifier StateMA
Identifier IssuerNETWORK HEALTH
# 6
Identifier01539
Identifier TypeOTHER
Identifier StateMA
Identifier IssuerAETNA US HEALTHCARE

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: