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NPI Code Detail

MEDICARE: FREDERICK P NISSLEY DO

MEDICARE: FREDERICK P NISSLEY DO
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
1208100000XPhysical Medicine & Rehabilitation Physician0S009450LPA

Other Identifiers

# Provider Identifier Provider Identifier Type Provider Identifier State Provider Identifier Issuer
1MEDICAID ID Found: Get Medicaid Details using Online Medicaid Verification Program

General Provider Information

NPI Number : 1922096122
Entity Type Code : Individual
Provider Name (Legal Business Name) : FREDERICK P NISSLEY DO
Provider Business Mailing Address
First Line : PO BOX 827783
Second Line : 2ND FLOOR HUDSON BUILDING
City : PHILADELPHIA
State : PA
Zip : 19182-7783
Country : US
Telephone Number : 215-707-3646
Fax Number : 215-707-3644
Provider Business Practice Location Address
First Line : 3401 N BROAD ST
Second Line : BSMT ROCK PAVILION
City : PHILADELPHIA
State : PA
Zip : 19140-5103
Country : US
Telephone Number : 215-707-3646
Fax Number : 215-707-6594
Authorized Official
Title or Position :
Name :
Credential :
Telephone Number :
Provider Enumeration Date : 10/11/2005
Last Update Date : 01/22/2010

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