Provider Demographics
NPI:1144332297
Name:NASTASKIN, ALEXEY
Entity type:Individual
Prefix:
First Name:ALEXEY
Middle Name:
Last Name:NASTASKIN
Suffix:
Gender:M
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:PO BOX 52036
Mailing Address - Street 2:9551 BUSTLETON AVENUE 2ND FLOOR
Mailing Address - City:PHILADELPHIA
Mailing Address - State:PA
Mailing Address - Zip Code:19115
Mailing Address - Country:US
Mailing Address - Phone:215-698-2220
Mailing Address - Fax:215-464-1808
Practice Address - Street 1:9551 BUSTLETON AVENUE
Practice Address - Street 2:2ND FLOOR
Practice Address - City:PHILADELPHIA
Practice Address - State:PA
Practice Address - Zip Code:19115
Practice Address - Country:US
Practice Address - Phone:215-698-2220
Practice Address - Fax:215-464-1808
Is Sole Proprietor?:No
Enumeration Date:2006-08-31
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
PAOC009655225X00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225X00000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersOccupational Therapist
Provider Identifiers
StateIdentifier IDID TypeIssuer
1015654200001OtherDPA
PA1015654200001Medicaid
1015654200001OtherDPA
PA1015654200001Medicaid
Q66611Medicare UPIN