Individual
FREDERICK P NISSLEY
Active
Sole proprietor
No
Provider details
NPI number
Gender
Man
Credential
DO
Contact information
Practice address
3401 N BROAD ST, BSMT ROCK PAVILION, PHILADELPHIA, PA 19140-5103
(215) 707-3646
(215) 707-6594
Mailing address
PO BOX 827783, 2ND FLOOR HUDSON BUILDING, PHILADELPHIA, PA 19182-7783
(215) 707-3646
(215) 707-3644
Taxonomy
Speciality
Code
Description
License number
State
208100000X
Physical Medicine & Rehabilitation Physician
Primary
0S009450L
PA
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
0018104530004
—
PA
Enumeration date
10/11/2005
Last updated
01/22/2010
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