Healthcare Provider Details

I. General information

NPI: 1093624900
Provider Name (Legal Business Name): NP IN FAMILY HEALTH ON CALL PLLC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 09/04/2026
Last Update Date: 09/09/2026
Certification Date: 09/09/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

441 LISLE RD
OWEGO NY
13827-1158
US

IV. Provider business mailing address

441 LISLE RD
OWEGO NY
13827-1158
US

V. Phone/Fax

Practice location:
  • Phone: 607-624-2080
  • Fax:
Mailing address:
  • Phone: 607-624-2080
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code363LF0000X
TaxonomyFamily Nurse Practitioner
License Number
License Number State

VIII. Authorized Official

Name: JUSTIN LOOMIS
Title or Position: MANAGING MEMBER
Credential: FNP
Phone: 607-624-2080