Individual
DR. JUSTIN ANTHONY NISTICO
Active
Sole proprietor
No
Provider details
NPI number
Gender
Man
Credential
D.O.
Contact information
Practice address
602 IVY ST FL 1, ELMIRA, NY 14905-1646
(607) 737-4577
(607) 367-5010
Mailing address
571 SAINT JOSEPHS BLVD, FL 2, ELMIRA, NY 14901-3230
(607) 271-2050
Taxonomy
Speciality
Code
Description
License number
State
207R00000X
Internal Medicine Physician
277019
NY
207RI0200X
Infectious Disease Physician
Primary
277019
NY
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
04209610
—
NY
05
—
103467400
—
PA
Enumeration date
04/09/2012
Last updated
11/25/2020
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