Healthcare Provider Details

I. General information

NPI: 1306243241
Provider Name (Legal Business Name): STEPHANIE MARIE PISTILLI D.O
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 11/20/2014
Last Update Date: 02/25/2019
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

3 COOPER PLAZA
CAMDEN NJ
08103
US

IV. Provider business mailing address

227 LAUREL RD STE 300
VOORHEES NJ
08043-8303
US

V. Phone/Fax

Practice location:
  • Phone: 856-342-2965
  • Fax: 856-365-1967
Mailing address:
  • Phone: 856-669-6050
  • Fax: 856-651-0794

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code207V00000X
TaxonomyObstetrics & Gynecology Physician
License Number25MB09592500
License Number StateNJ

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: