Healthcare Provider Details

I. General information

NPI: 1023170719
Provider Name (Legal Business Name): JOSEPH NASCA D.P.M.
Entity Type: Individual
Gender: Male
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 12/16/2006
Last Update Date: 11/28/2011
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

369 KENMORE AVE
BUFFALO NY
14223-2861
US

IV. Provider business mailing address

369 KENMORE AVE
BUFFALO NY
14223-2861
US

V. Phone/Fax

Practice location:
  • Phone: 716-833-0225
  • Fax: 716-833-2793
Mailing address:
  • Phone: 716-833-0225
  • Fax: 716-833-2793

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code213EP1101X
TaxonomyPrimary Podiatric Medicine Podiatrist
License NumberN003878-1
License Number StateNY
# 2
Primary TaxonomyN
Taxonomy Code213ES0131X
TaxonomyFoot Surgery Podiatrist
License NumberN003878-1
License Number StateNY

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: