Individual
ALEXEY NASTASKIN
Active
Sole proprietor
No
Provider details
NPI number
Gender
Man
Contact information
Practice address
9551 BUSTLETON AVENUE, 2ND FLOOR, PHILADELPHIA, PA 19115
(215) 698-2220
(215) 464-1808
Mailing address
PO BOX 52036, 9551 BUSTLETON AVENUE 2ND FLOOR, PHILADELPHIA, PA 19115
(215) 698-2220
(215) 464-1808
Taxonomy
Speciality
Code
Description
License number
State
225X00000X
Occupational Therapist
Primary
OC009655
PA
Other
Other identifiers
Code
Description
Identifier
Issuer
State
01
—
1015654200001
DPA
—
05
—
1015654200001
—
PA
Enumeration date
08/31/2006
Last updated
07/08/2007
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