Provider Demographics
NPI:1588116248
Name:JUSTOFIN, JAMES (CRNP)
Entity type:Individual
Prefix:
First Name:JAMES
Middle Name:
Last Name:JUSTOFIN
Suffix:
Gender:M
Credentials:CRNP
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:463 RIDGE RD
Mailing Address - Street 2:
Mailing Address - City:TELFORD
Mailing Address - State:PA
Mailing Address - Zip Code:18969-1440
Mailing Address - Country:US
Mailing Address - Phone:610-316-1164
Mailing Address - Fax:866-292-3662
Practice Address - Street 1:463 RIDGE RD
Practice Address - Street 2:
Practice Address - City:TELFORD
Practice Address - State:PA
Practice Address - Zip Code:18969-1440
Practice Address - Country:US
Practice Address - Phone:610-316-1164
Practice Address - Fax:866-292-3662
Is Sole Proprietor?:Yes
Enumeration Date:2016-10-28
Last Update Date:2021-06-24
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
PASP016743363LF0000X, 208VP0000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes363LF0000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerFamilyGroup - Multi-Specialty
No208VP0000XAllopathic & Osteopathic PhysiciansPain MedicinePain MedicineGroup - Multi-Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
PA103502564-0005Medicaid