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General NPI Number Information
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NPI Number | 1649463548
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Entity Type | Organization
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Legal Business Name | ADVANCED DIAGNOSTICS PC
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Dates
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Enumeration Date | 08/23/2007
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Last Update Date | 08/23/2007
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Provider Practice Location Address
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Address Line | 3519 BIGELOW BLVD
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City | PITTSBURGH
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State | PA
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Zip | 15213-1023
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Country | US
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Telephone | 412-683-8378
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Fax | 412-683-1215
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Provider Business Mailing Address
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Address Line | 3519 BIGELOW BLVD
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City | PITTSBURGH
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State | PA
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Zip | 15213-1023
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Country | US
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Telephone | 412-683-8378
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Fax | 412-683-1215
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Authorized Official
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Title or Position | OWNER/PSYCHOLOGIST
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Name | DR. GREGORY JON NICOSIA
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Credential | PH.D.
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Telephone | 412-683-8378
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 1041C0700X
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Taxonomy Name | Clinical Social Worker
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License Number |
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License Number State | PA
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Taxonomy #2
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Taxonomy Code | 103T00000X
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Taxonomy Name | Psychologist
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License Number |
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License Number State | PA
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