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General NPI Number Information
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NPI Number | 1477819951
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Entity Type | Individual
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Provider Name | JUSTIN ANTHONY NISTICO D.O.
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Gender | Male
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Dates
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Enumeration Date | 04/09/2012
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Last Update Date | 11/25/2020
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Provider Practice Location Address
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Address Line | 602 IVY ST FL 1
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City | ELMIRA
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State | NY
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Zip | 14905-1646
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Country | US
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Telephone | 607-737-4577
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Fax | 607-367-5010
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Provider Business Mailing Address
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Address Line | 571 SAINT JOSEPHS BLVD FL 2
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City | ELMIRA
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State | NY
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Zip | 14901-3230
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Country | US
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Telephone | 607-271-2050
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Fax |
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Authorized Official
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Title or Position |
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Name |
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Credential |
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Telephone |
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 207R00000X
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Taxonomy Name | Internal Medicine Physician
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License Number | 277019
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License Number State | NY
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Taxonomy #2
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Taxonomy Code | 207RI0200X
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Taxonomy Name | Infectious Disease Physician
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License Number | 277019
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License Number State | NY
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