Healthcare Provider Details

I. General information

NPI: 1730093428
Provider Name (Legal Business Name): MODEST MEDICINE HEALTH INC.
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 09/30/2026
Last Update Date: 09/30/2026
Certification Date: 09/30/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

713 BENNINGTON RD
FOLCROFT PA
19032-1714
US

IV. Provider business mailing address

125 WILDWOOD AVE
LANSDOWNE PA
19050-2728
US

V. Phone/Fax

Practice location:
  • Phone: 201-455-4789
  • Fax:
Mailing address:
  • Phone: 201-455-4789
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

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

VIII. Authorized Official

Name: MARIAMA BERETY
Title or Position: CHIEF EXECUTIVE OFFICER
Credential: NP
Phone: 201-455-4789