Healthcare Provider Details

I. General information

NPI: 1215910005
Provider Name (Legal Business Name): ANTHONY J ELISCO DO
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 11/25/2005
Last Update Date: 01/13/2023
Certification Date: 01/11/2023
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1112 S MILL ST
NEW CASTLE PA
16101-4629
US

IV. Provider business mailing address

333 LYNN BLVD
FARRELL PA
16121
US

V. Phone/Fax

Practice location:
  • Phone: 724-658-4564
  • Fax: 724-657-8563
Mailing address:
  • Phone:
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code207Q00000X
TaxonomyFamily Medicine Physician
License NumberOS001957L
License Number StatePA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: