Healthcare Provider Details

I. General information

NPI: 1699774620
Provider Name (Legal Business Name): WARREN A PASTERNACK D.P.M.
Entity Type: Individual
Gender: Male
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 07/20/2005
Last Update Date: 12/14/2009
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

B2 BRIER HILL CT
EAST BRUNSWICK NJ
08816-3348
US

IV. Provider business mailing address

3 JASON DR
E BRUNSWICK NJ
08816-3342
US

V. Phone/Fax

Practice location:
  • Phone: 732-254-9302
  • Fax: 732-613-4758
Mailing address:
  • Phone: 732-254-1007
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code213ES0103X
TaxonomyFoot & Ankle Surgery Podiatrist
License Number25MD00116600
License Number StateNJ

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: