Provider Demographics
NPI:1649491861
Name:FESTA, JOHN PHILIP (PA-C)
Entity type:Individual
Prefix:MR
First Name:JOHN
Middle Name:PHILIP
Last Name:FESTA
Suffix:
Gender:M
Credentials:PA-C
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Mailing Address - Street 1:53 SLEEPY HOLLOW RD
Mailing Address - Street 2:
Mailing Address - City:BYRAM TWP
Mailing Address - State:NJ
Mailing Address - Zip Code:07821-3227
Mailing Address - Country:US
Mailing Address - Phone:848-219-4151
Mailing Address - Fax:
Practice Address - Street 1:401 HAMBURG TPKE
Practice Address - Street 2:SUITE 105
Practice Address - City:WAYNE
Practice Address - State:NJ
Practice Address - Zip Code:07470-2154
Practice Address - Country:US
Practice Address - Phone:973-595-6066
Practice Address - Fax:973-595-1127
Is Sole Proprietor?:Yes
Enumeration Date:2007-05-02
Last Update Date:2017-08-27
Deactivation Date:
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Provider Licenses
StateLicense IDTaxonomies
NJ25MP00024200363A00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363A00000XPhysician Assistants & Advanced Practice Nursing ProvidersPhysician Assistant