Provider Demographics
NPI:1508152752
Name:PLASTIC SURGICAL ASSOCIATES OF JOHNSTOWN, INC
Entity Type:Organization
Organization Name:PLASTIC SURGICAL ASSOCIATES OF JOHNSTOWN, INC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:
Authorized Official - First Name:DANIEL
Authorized Official - Middle Name:R
Authorized Official - Last Name:NEVARRE
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:814-536-9000
Mailing Address - Street 1:415 NAPOLEON PL
Mailing Address - Street 2:
Mailing Address - City:JOHNSTOWN
Mailing Address - State:PA
Mailing Address - Zip Code:15901-2504
Mailing Address - Country:US
Mailing Address - Phone:814-536-9000
Mailing Address - Fax:
Practice Address - Street 1:415 NAPOLEON PL
Practice Address - Street 2:
Practice Address - City:JOHNSTOWN
Practice Address - State:PA
Practice Address - Zip Code:15901-2504
Practice Address - Country:US
Practice Address - Phone:814-536-9000
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:Yes
Parent Organization LBN:PLASTIC SURGICAL ASSOCIATES OF JOHNSTOWN, INC
Parent Organization TIN:<UNAVAIL>
Enumeration Date:2011-06-27
Last Update Date:2011-06-27
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes332B00000XSuppliersDurable Medical Equipment & Medical Supplies
Provider Identifiers
StateIdentifier IDID TypeIssuer
PA1250810001Medicare NSC