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: 06/29/2026
Certification Date: 06/29/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

440 HIGHWAY 34 N
COLTS NECK NJ
07722
US

IV. Provider business mailing address

440 HIGHWAY 34 N
COLTS NECK NJ
07722
US

V. Phone/Fax

Practice location:
  • Phone: 732-790-1760
  • Fax: 848-306-7174
Mailing address:
  • Phone: 732-790-1760
  • Fax: 848-306-7174

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: