Provider Demographics
NPI:1942836572
Name:JAMES JUSTOFIN CRNP LLC
Entity type:Organization
Organization Name:JAMES JUSTOFIN CRNP LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:SOLE PROPRIETOR/PROVIDER
Authorized Official - Prefix:
Authorized Official - First Name:JAMES
Authorized Official - Middle Name:
Authorized Official - Last Name:JUSTOFIN
Authorized Official - Suffix:
Authorized Official - Credentials:CRNP
Authorized Official - Phone:610-316-1164
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
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2020-03-15
Last Update Date:2021-06-24
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes363LF0000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerFamilyGroup - Single Specialty
No261QP3300XAmbulatory Health Care FacilitiesClinic/CenterPainGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
PA103760433-0001Medicaid