Frederick P Nissley, DO

Primary specialty

Physical Medicine & Rehabilitation PhysicianTaxonomy code 208100000X

License

0S009450L Issued in PA

Practice address

3401 N Broad St
BSMT Rock Pavilion
Philadelphia, PA 19140-5103

Phone

(215) 707-3646

Fax

(215) 707-6594

NPI assigned

Oct 11, 2005

Last updated

Jan 22, 2010By the provider in NPPES

Sex

Male

Sole proprietor

No

Registry information is reported by the provider to CMS and is not verified. About this source

Specialties & licenses 1

Addresses

Other identifiers 1

Medicare fee-for-service enrollment

Not listed in the public Medicare enrollment file

Medicare enrollment (NPD)

Enrolled

Credentials

Doctor of Osteopathy

State licenses

The complete NPPES record for this NPI in the NPI Registry API format.

{
    "created_epoch": "1128988800000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1264118400000",
    "number": "1922096122",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "PO BOX 827783",
            "address_2": "2ND FLOOR HUDSON BUILDING",
            "city": "PHILADELPHIA",
            "state": "PA",
            "postal_code": "191827783",
            "telephone_number": "215-707-3646",
            "fax_number": "215-707-3644"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "3401 N BROAD ST",
            "address_2": "BSMT ROCK PAVILION",
            "city": "PHILADELPHIA",
            "state": "PA",
            "postal_code": "191405103",
            "telephone_number": "215-707-3646",
            "fax_number": "215-707-6594"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "NISSLEY",
        "first_name": "FREDERICK",
        "middle_name": "P",
        "credential": "DO",
        "sole_proprietor": "NO",
        "sex": "M",
        "enumeration_date": "2005-10-11",
        "last_updated": "2010-01-22",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "208100000X",
            "taxonomy_group": "",
            "desc": "Physical Medicine & Rehabilitation",
            "state": "PA",
            "license": "0S009450L",
            "primary": true
        }
    ],
    "identifiers": [
        {
            "code": "05",
            "desc": "MEDICAID",
            "issuer": null,
            "identifier": "0018104530004",
            "state": "PA"
        }
    ],
    "endpoints": [],
    "other_names": []
}

• Taiki Nishihara, MD
• Shaina Nishimura, AU.D.
• Akira Nishisaki, MD
• Leah Nissle, MA, ATC
• Jenelle D. Nissley-Tsiopinis, PH.D.
• Kristine Nissley, CRNP
• Pichayut Nithagon, MD
• April E Nitkin, CRNP
• Stephanie Lynn Nitzschke, MD
• NG Tung Niu, CRNP

• Physical Medicine & Rehabilitation Physician in Philadelphia, PA
• Providers in Philadelphia, PA by specialty
• Physical Medicine & Rehabilitation Physician in Pennsylvania

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Jan 22, 2010; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
• National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.

Verify at the official NPI Registry.