Healthcare Provider Details

I. General information

NPI: 1316100191
Provider Name (Legal Business Name): JUSTIN D ENGLEKA CRNP
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 07/02/2008
Last Update Date: 10/13/2020
Certification Date: 10/13/2020
Deactivation Date:
Reactivation Date:

III. Provider practice location address

4815 LIBERTY AVE
PITTSBURGH PA
15224-2156
US

IV. Provider business mailing address

4815 LIBERTY AVE STE 115
PITTSBURGH PA
15224-2156
US

V. Phone/Fax

Practice location:
  • Phone: 412-578-6808
  • Fax: 412-688-7517
Mailing address:
  • Phone: 412-578-6808
  • Fax: 412-688-7517

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code363L00000X
TaxonomyNurse Practitioner
License NumberUP006375H
License Number StatePA
# 2
Primary TaxonomyY
Taxonomy Code363LG0600X
TaxonomyGerontology Nurse Practitioner
License NumberUP006375H
License Number StatePA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: