1306243241 NPI number — DR. STEPHANIE MARIE PISTILLI D.O

Table of content: DR. STEPHANIE MARIE PISTILLI D.O (NPI 1306243241)

General

This information contains only most important part of the NPI data, for complete information, including NPI referencing materials please refer to 1306243241 NPI number — DR. STEPHANIE MARIE PISTILLI D.O

Organization/Personal Information

Employer Identification Number (EIN):
Provider Organization Name:
Provider Last Name:
PISTILLI
Provider First Name:
STEPHANIE
Provider Middle Name:
MARIE
Provider Name Prefix Text:
DR.
Provider Name Suffix Text:
Provider Credential Text:
D.O
Provider Gender Code:
F

Provider's Other Name Information

Provider Other Organization Name:
Provider Other Organization Name Type Code:
Provider Other Last Name:
Provider Other First Name:
Provider Other Middle Name:
Provider Other Name Prefix Text:
Provider Other Name Suffix Text:
Provider Other Credential Text:
Provider Other Last Name Type Code:

NPI Number Information

NPI Number:
1306243241
Entity Type Code:
Individual
Replacement NPI:
Last Update Date:
02/25/2019
NPI Deactivation Reason Code:
NPI Deactivation Date:
NPI Reactivation Date:

Provider's Business Mailing Address

Provider First Line Business Mailing Address:
227 LAUREL RD
Provider Second Line Business Mailing Address:
STE 300
Provider Business Mailing Address City Name:
VOORHEES
Provider Business Mailing Address State Name:
NJ
Provider Business Mailing Address Postal Code:
08043-8303
Provider Business Mailing Address Country Code:
US
Provider Business Mailing Address Telephone Number:
856-669-6050
Provider Business Mailing Address Fax Number:
856-651-0794

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
3 COOPER PLAZA
Provider Second Line Business Practice Location Address:
Provider Business Practice Location Address City Name:
CAMDEN
Provider Business Practice Location Address State Name:
NJ
Provider Business Practice Location Address Postal Code:
08103
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
856-342-2965
Provider Business Practice Location Address Fax Number:
856-365-1967
Provider Enumeration Date:
11/20/2014

Additional Information

Authorized Official

Authorized Official Last Name:
Authorized Official First Name:
Authorized Official Middle Name:
Authorized Official Title or Position:
Authorized Official Telephone Number:

Provider Taxonomy Codes

  • Taxonomy code: 207V00000X , with the licence number:  25MB09592500 , registered in the state of NJ ; information, associated with the NPI states the following Primary Taxonomy Switch: "Y" .

Other Provider's Identifiers (legacy, non-NPI)





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