Provider Demographics
NPI:1407057748
Name:OFER J SHUSTIK MD PC
Entity Type:Organization
Organization Name:OFER J SHUSTIK MD PC
Other - Org Name:SHUSTIK FAMILY PRACTICE
Other - Org Type:Doing Business As
Authorized Official - Title/Position:MANAGER
Authorized Official - Prefix:MRS
Authorized Official - First Name:MARJORIE
Authorized Official - Middle Name:LOUISE
Authorized Official - Last Name:SICKLE
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:610-868-1836
Mailing Address - Street 1:2101 EMRICK BLVD
Mailing Address - Street 2:SUITE 202
Mailing Address - City:BETHLEHEM
Mailing Address - State:PA
Mailing Address - Zip Code:18020-8040
Mailing Address - Country:US
Mailing Address - Phone:610-868-1836
Mailing Address - Fax:610-868-1784
Practice Address - Street 1:2101 EMRICK BLVD
Practice Address - Street 2:SUITE 202
Practice Address - City:BETHLEHEM
Practice Address - State:PA
Practice Address - Zip Code:18020-8040
Practice Address - Country:US
Practice Address - Phone:610-868-1836
Practice Address - Fax:610-868-1784
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2007-05-31
Last Update Date:2020-08-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes207Q00000XAllopathic & Osteopathic PhysiciansFamily MedicineGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
PAG42871Medicare UPIN
PA016002Medicare ID - Type Unspecified