Healthcare Provider Details

I. General information

NPI: 1063338366
Provider Name (Legal Business Name): BRISTOT-WEST LLC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 06/29/2026
Last Update Date: 06/29/2026
Certification Date: 06/29/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

971 US HIGHWAY 202 N # 6719
BRANCHBURG NJ
08876-3757
US

IV. Provider business mailing address

971 US HIGHWAY 202 N # 6719
BRANCHBURG NJ
08876-3757
US

V. Phone/Fax

Practice location:
  • Phone: 432-243-4246
  • Fax:
Mailing address:
  • Phone:
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code332BC3200X
TaxonomyCustomized Equipment (DME)
License Number
License Number State

VIII. Authorized Official

Name: DEANNA R DISPENZA
Title or Position: OWNER
Credential:
Phone: 432-243-4246