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General NPI Number Information
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NPI Number | 1942836572
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Entity Type | Organization
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Legal Business Name | JAMES JUSTOFIN CRNP LLC
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Dates
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Enumeration Date | 03/15/2020
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Last Update Date | 06/24/2021
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Provider Practice Location Address
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Address Line | 463 RIDGE RD
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City | TELFORD
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State | PA
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Zip | 18969-1440
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Country | US
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Telephone | 610-316-1164
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Fax | 866-292-3662
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Provider Business Mailing Address
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Address Line | 463 RIDGE RD
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City | TELFORD
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State | PA
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Zip | 18969-1440
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Country | US
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Telephone | 610-316-1164
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Fax | 866-292-3662
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Authorized Official
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Title or Position | SOLE PROPRIETOR/PROVIDER
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Name | JAMES JUSTOFIN
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Credential | CRNP
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Telephone | 610-316-1164
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 261QP3300X
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Taxonomy Name | Pain Clinic/Center
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License Number |
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License Number State |
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Taxonomy #2
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Taxonomy Code | 363LF0000X
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Taxonomy Name | Family Nurse Practitioner
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License Number |
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License Number State |
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