Individual
DR. JAY MARLIN NISSLEY
Active
Sole proprietor
No
Provider details
NPI number
Gender
Man
Credential
M.D.
Contact information
Practice address
55 MEDICAL PARK DR, LEWISBURG, PA 17837-6343
(570) 523-3264
(570) 523-3465
Mailing address
55 MEDICAL PARK DR, LEWISBURG, PA 17837-6343
(570) 523-3264
(570) 523-3465
Taxonomy
Speciality
Code
Description
License number
State
208000000X
Pediatrics Physician
Primary
MD011004E
PA
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
0008831050003
—
PA
Enumeration date
10/04/2005
Last updated
11/10/2011
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