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General NPI Number Information
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NPI Number | 1275950446
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Entity Type | Organization
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Legal Business Name | DJB MED LLC
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Dates
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Enumeration Date | 03/25/2014
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Last Update Date | 08/14/2014
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Provider Practice Location Address
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Address Line | 21 YOST BLVD FOREST HILLS PLAZA SUITE 144
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City | PITTSBURGH
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State | PA
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Zip | 15221-5283
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Country | US
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Telephone | 412-816-1400
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Fax |
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Provider Business Mailing Address
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Address Line | 229 SHERYL LN
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City | PITTSBURGH
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State | PA
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Zip | 15221-3768
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Country | US
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Telephone |
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Fax |
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Authorized Official
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Title or Position | OWNER
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Name | JUSTIN BERTHOLD
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Credential | D.O.
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Telephone | 412-657-3347
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 208100000X
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Taxonomy Name | Physical Medicine & Rehabilitation Physician
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License Number | OS016640
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License Number State | PA
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