Healthcare Provider Details

I. General information

NPI: 1649463548
Provider Name (Legal Business Name): ADVANCED DIAGNOSTICS PC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 08/23/2007
Last Update Date: 08/23/2007
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

3519 BIGELOW BLVD
PITTSBURGH PA
15213-1023
US

IV. Provider business mailing address

3519 BIGELOW BLVD
PITTSBURGH PA
15213-1023
US

V. Phone/Fax

Practice location:
  • Phone: 412-683-8378
  • Fax: 412-683-1215
Mailing address:
  • Phone: 412-683-8378
  • Fax: 412-683-1215

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code103T00000X
TaxonomyPsychologist
License Number
License Number StatePA
# 2
Primary TaxonomyN
Taxonomy Code1041C0700X
TaxonomyClinical Social Worker
License Number
License Number StatePA

VIII. Authorized Official

Name: DR. GREGORY JON NICOSIA
Title or Position: OWNER/PSYCHOLOGIST
Credential: PH.D.
Phone: 412-683-8378