Healthcare Provider Details

I. General information

NPI: 1003113986
Provider Name (Legal Business Name): MR. FRED J. POPESKI
Entity Type: Individual
Gender: Male
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 02/11/2011
Last Update Date: 02/11/2011
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

4508 ZUCK RD
ERIE PA
16506-4523
US

IV. Provider business mailing address

5291 W 52ND ST
FAIRVIEW PA
16415-2334
US

V. Phone/Fax

Practice location:
  • Phone: 814-323-2104
  • Fax:
Mailing address:
  • Phone: 814-836-9955
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code175F00000X
TaxonomyNaturopath
License Number
License Number State

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: