MEDICARE: EUGENE DANIEL FESTA M.D., PH.D

Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

#	Taxonomy Code	Taxonomy	License Number	License Number State
1	207R00000X	Internal Medicine Physician	278229	NY
2	207R00000X	Internal Medicine Physician	25MA09229900	NJ

General Provider Information

NPI Number	:	1629395629
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	EUGENE DANIEL FESTA M.D., PH.D

Provider Business Mailing Address
First Line	:	PO BOX 95000, LB# 7550
Second Line	:
City	:	PHILADELPHIA
State	:	PA
Zip	:	19195-7550
Country	:	US
Telephone Number	:	844-362-1735
Fax Number	:

Provider Business Practice Location Address
First Line	:	1777 HAMBURG TPKE STE 304
Second Line	:
City	:	WAYNE
State	:	NJ
Zip	:	07470-5243
Country	:	US
Telephone Number	:	973-444-4558
Fax Number	:	973-444-7466

Authorized Official
Title or Position	:
Name	:
Credential	:
Telephone Number	:

Provider Enumeration Date	:	04/29/2010
Last Update Date	:	10/13/2025

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