Healthcare Provider Details

I. General information

NPI: 1598792566
Provider Name (Legal Business Name): PASCALE BASTIEN M.D.
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 06/27/2006
Last Update Date: 01/02/2020
Certification Date: 01/02/2020
Deactivation Date:
Reactivation Date:

III. Provider practice location address

8008 ROUTE 130 N, SUITE 204
DELRAN NJ
08075-1869
US

IV. Provider business mailing address

8008 ROUTE 130 NORTH, SUITE 204
DELRAN NJ
08075-1869
US

V. Phone/Fax

Practice location:
  • Phone: 856-824-0099
  • Fax: 856-824-0088
Mailing address:
  • Phone: 856-824-0099
  • Fax: 856-824-0088

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code2080A0000X
TaxonomyPediatric Adolescent Medicine Physician
License NumberMA64911
License Number StateNJ
# 2
Primary TaxonomyY
Taxonomy Code208000000X
TaxonomyPediatrics Physician
License Number25MA06491100
License Number StateNJ

VII. Legacy identifiers

For crosswalk purposes, the following legacy (non-NPI) identifiers are available for this provider:

# 1
Identifier7109407
Identifier TypeMEDICAID
Identifier StateNJ
Identifier Issuer

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: