Healthcare Provider Details

I. General information

NPI: 1144848680
Provider Name (Legal Business Name): TONY JOSEPH REOLA
Entity Type: Individual
Gender: Male
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 07/10/2020
Last Update Date: 02/01/2021
Certification Date: 02/01/2021
Deactivation Date:
Reactivation Date:

III. Provider practice location address

3005 BANKSVILLE RD
PITTSBURGH PA
15216-2718
US

IV. Provider business mailing address

3005 BANKSVILLE RD STE A
PITTSBURGH PA
15216-2718
US

V. Phone/Fax

Practice location:
  • Phone: 412-942-0702
  • Fax:
Mailing address:
  • Phone: 412-216-9413
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code363LF0000X
TaxonomyFamily Nurse Practitioner
License NumberSP022171
License Number StatePA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: