Healthcare Provider Details

I. General information

NPI: 1285797654
Provider Name (Legal Business Name): PLASTIC SURGICAL ASSOCIATES OF JOHNSTOWN INC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 12/18/2006
Last Update Date: 02/22/2012
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

415 NAPOLEON PL
JOHNSTOWN PA
15901-2504
US

IV. Provider business mailing address

415 NAPOLEON PL
JOHNSTOWN PA
15901-2504
US

V. Phone/Fax

Practice location:
  • Phone: 814-536-9000
  • Fax: 814-536-8999
Mailing address:
  • Phone: 814-536-9000
  • Fax: 814-536-8999

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code2086S0122X
TaxonomyPlastic and Reconstructive Surgery Physician
License Number
License Number State
# 2
Primary TaxonomyN
Taxonomy Code291U00000X
TaxonomyClinical Medical Laboratory
License Number032123
License Number StatePA

VIII. Authorized Official

Name: DR. DANIEL R NEVARRE
Title or Position: DIRECTOR/CEO
Credential: MD
Phone: 814-536-9000