Healthcare Provider Details

I. General information

NPI: 1457861973
Provider Name (Legal Business Name): PRISTINE PATH PLLC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 10/10/2017
Last Update Date: 06/16/2018
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

3408 BABCOCK BLVD
PITTSBURGH PA
15237-2402
US

IV. Provider business mailing address

1511 SHAKER CT
SEWICKLEY PA
15143-8790
US

V. Phone/Fax

Practice location:
  • Phone: 412-726-8857
  • Fax:
Mailing address:
  • Phone: 412-726-8857
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code207RA0401X
TaxonomyAddiction Medicine (Internal Medicine) Physician
License Number
License Number StatePA

VIII. Authorized Official

Name: MR. HARSHAL ARUN MULHERKAR
Title or Position: MANAGER
Credential:
Phone: 412-726-8857