Provider Demographics
NPI:1659426948
Name:CHRISTOPHER D. JUSTOFIN,D.O.,P.C.
Entity Type:Organization
Organization Name:CHRISTOPHER D. JUSTOFIN,D.O.,P.C.
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OFFICE MANAGER
Authorized Official - Prefix:
Authorized Official - First Name:KELLY
Authorized Official - Middle Name:O
Authorized Official - Last Name:JUSTOFIN
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:570-455-2286
Mailing Address - Street 1:106 ROTARY DR
Mailing Address - Street 2:
Mailing Address - City:W HAZLETON
Mailing Address - State:PA
Mailing Address - Zip Code:18202-1182
Mailing Address - Country:US
Mailing Address - Phone:570-455-2286
Mailing Address - Fax:
Practice Address - Street 1:106 ROTARY DR
Practice Address - Street 2:
Practice Address - City:W HAZLETON
Practice Address - State:PA
Practice Address - Zip Code:18202-1182
Practice Address - Country:US
Practice Address - Phone:570-455-2286
Practice Address - Fax:570-455-2336
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2007-01-24
Last Update Date:2011-12-28
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
PAOS008405L207Q00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes207Q00000XAllopathic & Osteopathic PhysiciansFamily MedicineGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
PAJU866998OtherPA BLUE SHIELD I.D.