Provider Demographics
NPI:1871557231
Name:FESTA, RONALD OREN (DC)
Entity type:Individual
Prefix:DR
First Name:RONALD
Middle Name:OREN
Last Name:FESTA
Suffix:
Gender:M
Credentials:DC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:320 CLAREMONT DR
Mailing Address - Street 2:
Mailing Address - City:LOWER BURRELL
Mailing Address - State:PA
Mailing Address - Zip Code:15068-2414
Mailing Address - Country:US
Mailing Address - Phone:724-337-7552
Mailing Address - Fax:
Practice Address - Street 1:706 STEVENSON BLVD
Practice Address - Street 2:
Practice Address - City:NEW KENSINGTON
Practice Address - State:PA
Practice Address - Zip Code:15068-5371
Practice Address - Country:US
Practice Address - Phone:724-335-5210
Practice Address - Fax:724-335-5981
Is Sole Proprietor?:Yes
Enumeration Date:2006-04-13
Last Update Date:2020-11-04
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
PADC004943L111N00000X
PANA208100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes208100000XAllopathic & Osteopathic PhysiciansPhysical Medicine & RehabilitationGroup - Multi-Specialty
No111N00000XChiropractic ProvidersChiropractor
Provider Identifiers
StateIdentifier IDID TypeIssuer
PA712021Medicare ID - Type Unspecified
PAU28802Medicare UPIN