Healthcare Provider Details

I. General information

NPI: 1083558977
Provider Name (Legal Business Name): STEPHANIE PISTILLI DO LLC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 04/20/2026
Last Update Date: 04/20/2026
Certification Date: 04/19/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

440 ROUTE 34
COLTS NECK NJ
07722-2525
US

IV. Provider business mailing address

5 LAKEVIEW TER
COLTS NECK NJ
07722-1473
US

V. Phone/Fax

Practice location:
  • Phone: 917-991-3204
  • Fax:
Mailing address:
  • Phone: 917-991-3204
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code202D00000X
TaxonomyIntegrative Medicine Physician
License Number
License Number State
# 2
Primary TaxonomyY
Taxonomy Code207VG0400X
TaxonomyGynecology Physician
License Number
License Number State

VIII. Authorized Official

Name: DR. STEPHANIE MARIE PISTILLI
Title or Position: PHYSICIAN OWNER
Credential: DO FACOG MSCP
Phone: 917-991-3204