Basic Information
| Provider Information | |||||||||
| NPI: | 1326198490 | ||||||||
| EntityType: | 1 | ||||||||
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| OrganizationName: | |||||||||
| LastName: | TESTA | ||||||||
| FirstName: | DAVID | ||||||||
| MiddleName: | A | ||||||||
| NamePrefix: | DR. | ||||||||
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| Credential: | D.O. | ||||||||
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| Mailing Information | |||||||||
| Address1: | 206 E BROWN ST | ||||||||
| Address2: | POCONO HEALTH SYSTEM - PROFESSIONAL CENTER | ||||||||
| City: | EAST STROUDSBURG | ||||||||
| State: | PA | ||||||||
| PostalCode: | 183013006 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 5704204951 | ||||||||
| FaxNumber: | 5704763513 | ||||||||
| Practice Location | |||||||||
| Address1: | 1089 ROUTE 390 | ||||||||
| Address2: | |||||||||
| City: | CRESCO | ||||||||
| State: | PA | ||||||||
| PostalCode: | 183267907 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 5704202450 | ||||||||
| FaxNumber: | 5704202442 | ||||||||
| Other Information | |||||||||
| ProviderEnumerationDate: | 01/11/2007 | ||||||||
| LastUpdateDate: | 07/20/2016 | ||||||||
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| ProviderGenderCode: | M | ||||||||
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| IsSoleProprietor: | Y | ||||||||
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Taxonomy Information
| Taxonomy | License | State | Switch | TaxonomyGroup | TaxonomyType | TaxonomyClass | SubSpecialty | 207Q00000X | 25MB69131 | NJ | N | Allopathic & Osteopathic Physicians | Family Medicine | 207Q00000X | OS017701 | PA | Y | Allopathic & Osteopathic Physicians | Family Medicine |
ID Information
| ID | Type | State | Issuer | Description | 8291900 | 05 | NJ | MEDICAID |